|
1
|
Xue Y, Song M, Chen X, Ruan Z, Zou H, Lai Y, Yao D, Ung COL, Hu H. Consolidating International Care Models and Clinical Services for Adult Obesity. Curr Obes Rep 2025; 14:26. [PMID: 40153156 DOI: 10.1007/s13679-025-00621-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/18/2025] [Indexed: 03/30/2025]
Abstract
PURPOSE OF REVIEW This paper aims to analyze and consolidate the existing evidence on models of care and clinical obesity services for adults living with obesity 1) to identify the key components of clinical obesity services, and 2) to propose recommendations for future directions of promoting the international development of clinical obesity care. RECENT FINDINGS The key components of clinical obesity services include 1) a contextualized composition of multi-disciplinary teams and mechanisms to empower the healthcare professionals, 2) clear stepwise pathways matching patient needs with appropriate clinical and community resources in a timely manner, 3) comprehensive assessment and individualized treatment plan informed by the evidence-based clinical practice guidelines. Furthermore, clinical information systems and financing resources are instrumental to the effective and sustainable functioning of a comprehensive clinical service with strong connections across primary, secondary and tertiary levels of care. We synthesized these findings to make recommendations for healthcare practitioners, hospital administrations and policymakers in developing and improving comprehensive clinical services to address the needs of adults living with obesity.
Collapse
Affiliation(s)
- Yan Xue
- State Key Laboratory of Quality Research in Chinese Medicine, Institute of Chinese Medical Sciences, University of Macau, Macao, China
| | - Menghuan Song
- State Key Laboratory of Quality Research in Chinese Medicine, Institute of Chinese Medical Sciences, University of Macau, Macao, China
- Centre for Pharmaceutical Regulatory Sciences, University of Macau, Macao, China
| | - Xianwen Chen
- State Key Laboratory of Quality Research in Chinese Medicine, Institute of Chinese Medical Sciences, University of Macau, Macao, China
| | - Zhen Ruan
- State Key Laboratory of Quality Research in Chinese Medicine, Institute of Chinese Medical Sciences, University of Macau, Macao, China
| | - Huimin Zou
- State Key Laboratory of Quality Research in Chinese Medicine, Institute of Chinese Medical Sciences, University of Macau, Macao, China
| | - Yunfeng Lai
- School of Public Health and Management, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Dongning Yao
- School of Pharmacy, Nanjing Medical University, Nanjing, China
| | - Carolina Oi Lam Ung
- State Key Laboratory of Quality Research in Chinese Medicine, Institute of Chinese Medical Sciences, University of Macau, Macao, China.
- Centre for Pharmaceutical Regulatory Sciences, University of Macau, Macao, China.
- Department of Public Health and Medicinal Administration, Faculty of Health Sciences, University of Macau, Macao, China.
| | - Hao Hu
- State Key Laboratory of Quality Research in Chinese Medicine, Institute of Chinese Medical Sciences, University of Macau, Macao, China.
- Centre for Pharmaceutical Regulatory Sciences, University of Macau, Macao, China.
- Department of Public Health and Medicinal Administration, Faculty of Health Sciences, University of Macau, Macao, China.
| |
Collapse
|
|
2
|
Bos P, Danhieux K, Wouters E, Olmen JV, Buffel V. Navigating diabetes care inequities: an observational study linking chronic care model's structural elements to process and outcomes of type 2 diabetes care in Belgium. Int J Equity Health 2025; 24:15. [PMID: 39828686 PMCID: PMC11744845 DOI: 10.1186/s12939-024-02372-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2024] [Accepted: 12/25/2024] [Indexed: 01/22/2025] Open
Abstract
BACKGROUND Although the Chronic Care Model (CCM) provides the essential structural components of practice organisation to deliver high-quality type 2 diabetes (T2D) care, little is known about which of its elements are most important, and the extent to which it may reduce social inequities in the quality of T2D care. This study aims to assess the association between the implementation of CCM's structural elements and the quality of T2D care processes and outcomes in Flanders (Belgium), paying specific attention to differences by patients' socioeconomic vulnerability. METHODS We developed a longitudinal database combining information on primary care practices' CCM implementation, with individual-level health insurance and medical lab data. Our sample included 7,593 T2D patients aged 40 years and above from 58 primary care practices in Flanders, followed up from 2017 to 2019. Medical lab data were available for a subsample of 4,549 patients. By estimating a series of hierarchical mixed-effects models, we assessed the association between primary care practices' CCM implementation and two process and two outcome indicators of T2D care. In addition, we explored cross-level interactions with patients' socioeconomic vulnerability. RESULTS Patients were more likely to have their HbA1c tested twice a year and LDL cholesterol tested yearly in practices with a higher overall CCM implementation. Regarding the different CCM elements, the clinical information system and linkages to the community were significantly associated with higher odds of being up-to-date with HbA1c testing, whereas stronger community linkages was the only dimension significantly associated with yearly LDL cholesterol testing. While socioeconomic vulnerable patients were less likely to have their HbA1c tested twice yearly, this difference disappeared in the highest-scoring practices. Regarding the outcome indicators, only a negligible proportion of variation in HbA1c and LDL cholesterol levels was due to systematic differences between practices, and hence, no clinically relevant associations with the CCM elements were found. CONCLUSION Our pioneering findings support the social capital pathway, as CCM implementation is associated with a reduction in the healthcare inequity gap in the T2D care process. This suggests that promoting CCM implementation may improve healthcare equity, particularly in regions with significant socioeconomic disparities or high concentrations of deprived individuals.
Collapse
Affiliation(s)
- Philippe Bos
- Department of Sociology, University of Antwerp, Antwerp, Belgium.
| | - Katrien Danhieux
- Department of Family Medicine and Population Health, University of Antwerp, Antwerp, Belgium
| | - Edwin Wouters
- Department of Sociology, University of Antwerp, Antwerp, Belgium
| | - Josefien van Olmen
- Department of Family Medicine and Population Health, University of Antwerp, Antwerp, Belgium
| | - Veerle Buffel
- Department of Sociology, Vrije Universiteit Brussel, Brussels, Belgium
| |
Collapse
|
|
3
|
Al‐Qahtani AA. Improving outcomes of type 2 diabetes mellitus patients in primary care with Chronic Care Model: A narrative review. J Gen Fam Med 2024; 25:171-178. [PMID: 38966652 PMCID: PMC11221057 DOI: 10.1002/jgf2.659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 10/30/2023] [Accepted: 11/07/2023] [Indexed: 07/06/2024] Open
Abstract
Designed and implemented over two decades ago, the Chronic Care Model is a well-established chronic disease management framework that has steered several healthcare systems in successfully improving the clinical outcomes of patients with type 2 diabetes mellitus. Research evidence cements the role of the Chronic Care Model (with its six key elements of organization of healthcare delivery system, self-management support, decision support, delivery system design, clinical information systems, and community resources and policies) as an integrated framework to revamp the type 2 diabetes mellitus-related clinical practice and care that betters the patient care and clinical outcomes. The current review is an evidence-lit summary of importance of use of Chronic Care Model in primary care and their impact on clinical outcomes for patients afflicted with one of the most debilitating metabolic diseases, type 2 diabetes mellitus.
Collapse
Affiliation(s)
- Arwa Ahmed Al‐Qahtani
- Department of Family Medicine, College of MedicineAl‐Imam Mohammed Ibn Saud Islamic UniversityRiyadhSaudi Arabia
| |
Collapse
|
|
4
|
Vincenzo JL, Bergen G, Casey CM, Eckstrom E. Reframing Fall Prevention and Risk Management as a Chronic Condition Through the Lens of the Expanded Chronic Care Model: Will Integrating Clinical Care and Public Health Improve Outcomes? THE GERONTOLOGIST 2024; 64:gnae035. [PMID: 38666718 PMCID: PMC11149378 DOI: 10.1093/geront/gnae035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Indexed: 06/05/2024] Open
Abstract
Falls are a leading cause of morbidity and mortality among adults aged 65 years and older (older adults) and are increasingly recognized as a chronic condition. Yet, fall-related care is infrequently provided in a chronic care context despite fall-related death rates increasing by 41% between 2012 and 2021. One of the many challenges to addressing falls is the absence of fall-focused chronic disease management programs, which improve outcomes of other chronic conditions, like diabetes. Policies, information systems, and clinical-community connections help form the backbone of chronic disease management programs, yet these elements are often missing in fall prevention. Reframing fall prevention through the Expanded Chronic Care Model (ECCM) guided by implementation science to simultaneously support the uptake of evidence-based practices could help improve the care of older adults at risk for falling. The ECCM includes seven components: (1) self-management/develop personal skills, (2) decision support, (3) delivery system design/re-orient health services, (4) information systems, (5) build healthy public policy, (6) create supportive environments, and (7) strengthen community action. Applying the ECCM to falls-related care by integrating health care delivery system changes, community resources, and public policies to support patient-centered engagement for self-management offers the potential to prevent falls more effectively among older adults.
Collapse
Affiliation(s)
- Jennifer L Vincenzo
- Department of Physical Therapy and Center for Implementation Research, Fayetteville, Arkansas, USA
| | - Gwen Bergen
- National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Colleen M Casey
- Department of Internal Medicine, Providence Senior Health, Portland, Oregon, USA
| | - Elizabeth Eckstrom
- Division of General Internal Medicine & Geriatrics, Department of Medicine, Oregon Health & Science University, Portland, Oregon, USA
| |
Collapse
|
|
5
|
Guldemond N. What is meant by 'integrated personalized diabetes management': A view into the future and what success should look like. Diabetes Obes Metab 2024; 26 Suppl 1:14-29. [PMID: 38328815 DOI: 10.1111/dom.15476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 01/12/2024] [Accepted: 01/15/2024] [Indexed: 02/09/2024]
Abstract
Integrated personalized diabetes management (IPDM) has emerged as a promising approach to improving outcomes in patients with diabetes mellitus (DM). This care approach emphasizes the integration and coordination of different providers, including physicians, nurses, dietitians, social workers and pharmacists. The goal of IPDM is to provide patients with personalized care that is tailored to their needs. This review addresses the concept of integrated care and the use of technology (including data, software applications and artificial intelligence) as well as managerial, regulatory and financial aspects. The implementation and upscaling of digitally enabled IPDM are discussed, with elaboration of successful practices and related evidence. Finally, recommendations are made. It is concluded that the adoption of digitally enabled IPDM on a global level is inevitable, considering the challenges created by an increasing prevalence of patients with DM and the need for better outcomes and improvement of health system sustainability.
Collapse
Affiliation(s)
- Nick Guldemond
- Department of Public Health and Primary Care, Leiden Universitair Medisch Centrum, Leiden, Netherlands
| |
Collapse
|
|
6
|
Abdul-Halim MAZ, Baharudin N, Abdul-Hamid H, Mohamed-Yassin MS, Daud MH, Badlishah-Sham SF, Abdul-Razak S, Ramli AS. Factors associated with usability of the EMPOWER-SUSTAIN Global Cardiovascular Risks Self-Management Booklet© among individuals with metabolic syndrome in primary care: a cross-sectional study. BMC PRIMARY CARE 2024; 25:51. [PMID: 38310212 PMCID: PMC10837927 DOI: 10.1186/s12875-024-02281-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 01/17/2024] [Indexed: 02/05/2024]
Abstract
BACKGROUND Self-management support has been recognized as one of the most essential elements of the Chronic Care Model (CCM). Inspired by the CCM, the EMPOWER-SUSTAIN Global Cardiovascular Risks Self-Management Booklet© was developed to aid and sustain self-management among patients with metabolic syndrome (MetS) in primary care to prevent cardiovascular complications. However, the usability of this booklet among these patients is not known. Therefore, this study aimed to evaluate the usability of this self-management booklet and identify the factors associated with its usability among patients with MetS in primary care. METHODS This cross-sectional study was conducted among patients with MetS attending a university primary care clinic in Selangor, Malaysia. The usability score was measured using a previously translated and validated EMPOWER-SUSTAIN Usability Questionnaire (E-SUQ) with a score of > 68 indicating good usability. Multiple logistic regressions determined the factors associated with its usability. RESULTS A total of 391 patients participated in this study. More than half (61.4%) had a good usability score of > 68, with a mean (± SD) usability score of 72.8 (± 16.1). Participants with high education levels [secondary education (AOR 2.46, 95% CI 1.04, 5.83) and tertiary education (AOR 2.49, 95% CI 1.04, 5.96)], those who used the booklet at home weekly (AOR 2.94, 95% CI 1.63, 5.33) or daily (AOR 2.73, 95% CI 1.09, 6.85), and those who had social support to use the booklet (AOR 1.64, 95% CI 1.02, 2.64) were significantly associated with good usability of the booklet. CONCLUSIONS The usability of the EMPOWER-SUSTAIN Global Cardiovascular Risks Self-Management Booklet© was good among patients with MetS in this primary care clinic, which supports its widespread use as a patient empowerment tool. The findings of this study also suggest that it is vital to encourage daily or weekly use of this booklet at home, with the support of family members. The focus should also be given to those with lower education to improve the usability of this booklet for this group of patients.
Collapse
Affiliation(s)
- Mohamad Abu Zar Abdul-Halim
- Department of Primary Care Medicine, Faculty of Medicine, Universiti Teknologi MARA, Sungai Buloh, Selangor, 47000, Malaysia
| | - Noorhida Baharudin
- Department of Primary Care Medicine, Faculty of Medicine, Universiti Teknologi MARA, Sungai Buloh, Selangor, 47000, Malaysia
- Institute of Pathology, Laboratory and Forensic Medicine (I-PPerForM), Universiti Teknologi MARA, Sungai Buloh, Selangor, 47000, Malaysia
| | - Hasidah Abdul-Hamid
- Department of Primary Care Medicine, Faculty of Medicine, Universiti Teknologi MARA, Sungai Buloh, Selangor, 47000, Malaysia
| | - Mohamed-Syarif Mohamed-Yassin
- Department of Primary Care Medicine, Faculty of Medicine, Universiti Teknologi MARA, Sungai Buloh, Selangor, 47000, Malaysia
| | - Maryam Hannah Daud
- Netherlands Maritime University College (NMUC), Johor Bahru, Johor, 80000, Malaysia
| | - Siti Fatimah Badlishah-Sham
- Department of Primary Care Medicine, Faculty of Medicine, Universiti Teknologi MARA, Sungai Buloh, Selangor, 47000, Malaysia
| | - Suraya Abdul-Razak
- Department of Primary Care Medicine, Faculty of Medicine, Universiti Teknologi MARA, Sungai Buloh, Selangor, 47000, Malaysia
- Institute of Pathology, Laboratory and Forensic Medicine (I-PPerForM), Universiti Teknologi MARA, Sungai Buloh, Selangor, 47000, Malaysia
- Cardio Vascular and Lungs Research Institute (CaVaLRI), Hospital Al-Sultan Abdullah, Universiti Teknologi MARA, Bandar Puncak Alam, Selangor, 42300, Malaysia
| | - Anis Safura Ramli
- Department of Primary Care Medicine, Faculty of Medicine, Universiti Teknologi MARA, Sungai Buloh, Selangor, 47000, Malaysia.
- Institute of Pathology, Laboratory and Forensic Medicine (I-PPerForM), Universiti Teknologi MARA, Sungai Buloh, Selangor, 47000, Malaysia.
| |
Collapse
|
|
7
|
Gow K, Rashidi A, Whithead L. Factors Influencing Medication Adherence Among Adults Living with Diabetes and Comorbidities: a Qualitative Systematic Review. Curr Diab Rep 2024; 24:19-25. [PMID: 38112977 PMCID: PMC10798913 DOI: 10.1007/s11892-023-01532-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/05/2023] [Indexed: 12/21/2023]
Abstract
PURPOSE OF REVIEW Medication adherence plays an important role in improving health outcomes related to diabetes and comorbidity. The potential factors influencing medication adherence and how they contribute to health behaviors have not been synthesized to date. This review synthesized qualitative studies that identified factors influencing medication adherence among adults living with diabetes and comorbidity. RECENT FINDINGS Twenty-eight findings were extracted and synthesized into four themes: perceived support, lack of knowledge, medication issues, and the importance of routine. The findings highlight the factors that support medication adherence and areas that can be targeted to support and promote medication adherence. The findings also support the potential role of healthcare providers in supporting people living with diabetes and comorbidity to adhere to and maintain medication regimes. Several factors were identified that are amenable to intervention within the clinical practice setting and have the potential to enhance medication adherence and improve health outcomes for people living with diabetes and comorbidities. The development of acceptable and effective interventions could have a positive effect on medication adherence and health outcomes.
Collapse
Affiliation(s)
- Kendall Gow
- Hollywood Private Hospital, 115 Monash Ave, Nedlands, WA, 6009, Australia
| | - Amineh Rashidi
- School of Nursing and Midwifery, Edith Cowan University Joondalup Campus, Joondalup, WA, 6027, Australia.
| | - Lisa Whithead
- School of Nursing and Midwifery, Edith Cowan University Joondalup Campus, Joondalup, WA, 6027, Australia
| |
Collapse
|
|
8
|
Mphasha MH, Skaal L, Mothibal T. Diet and exercise knowledge and practices for diabetes care within families in Senwabarwana. S Afr Fam Pract (2004) 2024; 66:e1-e8. [PMID: 38299525 PMCID: PMC10839224 DOI: 10.4102/safp.v66i1.5767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 09/26/2023] [Accepted: 09/27/2023] [Indexed: 02/02/2024] Open
Abstract
BACKGROUND Family members (FMs) are a valuable source of support, as the bulk of daily diabetes treatment occurs at home. Family members' insufficient understanding of patient support can lead to poor diabetes outcomes. Lack of knowledge about good diet and exercise can lead to unhealthy food preparation and sedentary lifestyles, affecting patients and increasing the risk of diabetes. This study aims to fill the gap in the level of knowledge of FMs relating to appropriate care for diabetic patients under their care. This will relate specifically to diet and exercise. METHODS A cross-sectional survey conducted in Senwabarwana, Limpopo province, involved 200 FMs caring for diabetic patients for at least 6 months. Their experience could offer valuable insights into the competence of their care. Data were collected regarding knowledge and practice using a close-ended questionnaire, with Likert scale responses and SPSS analysis, including descriptive statistics and chi-squared tests. Knowledge was assessed on a scale ranging from poor to excellent: poor (0% - 50%), fair (51% - 60%), good (61% - 74%) and excellent ( 75%). Practice was assessed as poor (0% - 50%), fair (51% - 69%) and good (70% - 100%). RESULTS Thirty-one percent of participants demonstrated excellent knowledge and only 9% demonstrated good practice. Unfortunately, 53% stated that obese patients with diabetes should skip meals to lose weight. Only 3.5% and 19%, respectively, are familiar with recommendations for exercise and glucose monitoring. Barely 35.5% of FMs eat breakfast every day, while 87.5% report exercising. CONCLUSION Few FMs possess excellent diabetes management knowledge but still indulge in bad practices, increasing their risk of developing diabetes. Additionally, they may potentially cause health problems for patients.Contribution: Family-centred behaviour change intervention is recommended.
Collapse
Affiliation(s)
- Mabitsela H Mphasha
- Department of Public Health, Faculty of Healthcare Sciences, University of Limpopo, Polokwane.
| | | | | |
Collapse
|
|
9
|
Kakara RS, Lee R, Eckstrom EN. Cause-Specific Mortality Among Adults Aged ≥65 Years in the United States, 1999 Through 2020. Public Health Rep 2024; 139:54-58. [PMID: 36905313 PMCID: PMC10905760 DOI: 10.1177/00333549231155869] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/12/2023] Open
Abstract
OBJECTIVE Reports on recent mortality trends among adults aged ≥65 years are lacking. We examined trends in the leading causes of death from 1999 through 2020 among US adults aged ≥65 years. METHODS We used data from the National Vital Statistics System mortality files to identify the 10 leading causes of death among adults aged ≥65 years. We calculated overall and cause-specific age-adjusted death rates and then calculated the average annual percentage change (AAPC) in death rates from 1999 through 2020. RESULTS The overall age-adjusted death rate decreased on average by 0.5% (95% CI, -1.0% to -0.1%) per year from 1999 through 2020. Although rates for 7 of the top 10 causes of death decreased significantly, the rates of death from Alzheimer disease (AAPC = 3.0%; 95% CI, 1.5% to 4.5%) and from unintentional injuries (AAPC = 1.2%; 95% CI, 1.0% to 1.4%), notably falls (AAPC = 4.1%; 95% CI, 3.9% to 4.3%) and poisoning (AAPC = 6.6%; 95% CI, 6.0% to 7.2%), increased significantly. CONCLUSION Public health prevention strategies and improved chronic disease management may have contributed to decreased rates in the leading causes of death. However, longer survival with comorbidities may have contributed to increased rates of death from Alzheimer disease and unintentional falls.
Collapse
Affiliation(s)
- Ramakrishna S. Kakara
- National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Robin Lee
- National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Elizabeth N. Eckstrom
- Division of General Internal Medicine and Geriatrics, Department of Medicine, Oregon Health & Science University, Portland, OR, USA
| |
Collapse
|
|
10
|
Lubega M, Ogwok J, Nabunya B, Mbalinda SN. Role of community-based health clubs in promoting patients' health education for diabetes self-care management: an interventional qualitative study in a Ugandan urban setting. BMJ Open Qual 2023; 12:e002473. [PMID: 38135300 DOI: 10.1136/bmjoq-2023-002473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Accepted: 12/02/2023] [Indexed: 12/24/2023] Open
Abstract
BACKGROUND Self-care management support is a core component of the Chronic Care Model that emphasises the need for empowering and preparing patients to manage their healthcare. In diabetes mellitus (DM) management, health education towards self-care empowers patients to make day-to-day decisions on their own disease and live with a healthy lifestyle. Although several strategies have been undertaken to improve the management of DM in Uganda, little has been done to empower patients to manage their own health. Community-based health clubs have been suggested as a novel way of improving diabetes management especially in settings with uneven distribution of healthcare facilities and inaccessibility to healthcare services that limit patients' awareness of the disease and self-care management. This interventional study was aimed at exploring the role of community-based health clubs in promoting patients' health education for diabetes self-care management. METHODS A cross-sectional qualitative study was conducted among 20 participants using focus group discussions with each having six to eight members. Only patients with diabetes who seek routine diabetes healthcare services at Wakiso Health Centre IV and had participated in the 8-week community-based health clubs' health education sessions were recruited for the study. The audio-recordings were transcribed verbatim and translated into English; thematic data analysis was conducted to generate codes and themes. Similar codes were merged and a group consensus was reached on coding discrepancies. RESULTS Three major themes on the role of health clubs in promoting patients' health education were merged from the study. These include promoting sharing of experiences among patients, improving awareness of healthy self-care practices and offering sufficient patient-health worker interaction time. CONCLUSIONS This is the first publication reporting on the role of community-based health clubs in promoting patients' health education towards diabetes self-care management in Uganda. The ability to share experiences among patients, improve patients' awareness on healthy living practices and the increased health worker-patient interaction time contribute heavily to the capacity-building for self-care among patients.
Collapse
Affiliation(s)
- Martin Lubega
- Department of Nursing, Makerere University College of Health Sciences, Kampala, Uganda
| | - James Ogwok
- Makerere University College of Health Sciences, Kampala, Uganda
| | - Brenda Nabunya
- Department of Nursing, Makerere University College of Health Sciences, Kampala, Uganda
| | | |
Collapse
|
|
11
|
Molló À, Vlacho B, Gratacòs M, Mata-Cases M, Rubinat E, Berenguera Ossó A, Cos FX, Franch-Nadal J, Khunti K, Mauricio D. A multicomponent health care intervention is associated with improved glycaemic control in subjects with poorly controlled type 2 diabetes compared with routine care: The INTEGRA study. Diabetes Obes Metab 2023; 25:3549-3559. [PMID: 37608473 DOI: 10.1111/dom.15250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 07/28/2023] [Accepted: 08/02/2023] [Indexed: 08/24/2023]
Abstract
AIM The INTEGRA study evaluated whether a specially designed multicomponent health care intervention improved glycaemic control in subjects with poorly controlled type 2 diabetes compared with standard of care practice. RESEARCH DESIGN AND METHODS Pragmatic study in subjects from primary care centres with type 2 diabetes and glycated haemoglobin (HbA1c) >9% (75 mmol/mol). The multifaceted intervention (N = 225 subjects) included a diabetes-focused visit encouraging therapeutic intensification by health care professionals. Retrospective data from matched controls (N = 675) were obtained from electronic medical records of a primary care database. The primary outcome was to compare the change in HbA1c values between the groups at 12 months of follow-up. RESULTS The mean HbA1c decreased substantially in both groups after 3 months, and the mean reduction was significantly greater in the intervention group than in the usual care group after 12 months [mean difference -0.66% (-7 mmol/mol), 95% CI -0.4, -1.0; p < .001]. A larger percentage of participants in the intervention group achieved HbA1c <7% and <8% goals (15.5% vs. 5.3% and 29.3% vs. 13.5%, respectively; p < .001). The improvement in HbA1c levels was sustained throughout the study only in the intervention arm. Glucose-lowering therapy was more frequently intensified in patients in the intervention group at the initial and final time points of the study (between 0-3 and 6-12 months; p < .001), with a significant increase in the number of patients prescribed ≥2 antidiabetic therapies (p < .001). CONCLUSIONS A multifaceted intervention oriented at reducing therapeutic inertia by primary care physicians was associated with greater improvement in glycaemic control compared with patients treated as per usual care.
Collapse
Affiliation(s)
- Àngels Molló
- DAP-Cat group, Unitat de Suport a la Recerca Barcelona, Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
| | - Bogdan Vlacho
- DAP-Cat group, Unitat de Suport a la Recerca Barcelona, Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
- CIBER of Diabetes and Associated Metabolic Diseases (CIBERDEM), Instituto de Salud Carlos III (ISCIII), Barcelona, Spain
| | - Mònica Gratacòs
- DAP-Cat group, Unitat de Suport a la Recerca Barcelona, Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
| | - Manel Mata-Cases
- DAP-Cat group, Unitat de Suport a la Recerca Barcelona, Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
- CIBER of Diabetes and Associated Metabolic Diseases (CIBERDEM), Instituto de Salud Carlos III (ISCIII), Barcelona, Spain
| | - Esther Rubinat
- CIBER of Diabetes and Associated Metabolic Diseases (CIBERDEM), Instituto de Salud Carlos III (ISCIII), Barcelona, Spain
- Health Care Research Group (GRECS), Lleida Institute for Biomedical Research Dr. Pifarré Foundation IRB Lleida, University of Lleida, Lleida, Spain
- Department of Nursing & Physiotherapy, Serra Hunter Lecture, University of Lleida, Lleida, Spain
- Society, Health, Education and Culture Research Group (GESEC) of the University of Lleida, Lleida, Spain
| | - Anna Berenguera Ossó
- Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
- Departament d'Infermeria, Universitat de Girona, Girona, Spain
- Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - Francesc Xavier Cos
- DAP-Cat group, Unitat de Suport a la Recerca Barcelona, Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
- Innovation Office at Institut Català de la Salut, Barcelona, Spain
| | - Josep Franch-Nadal
- DAP-Cat group, Unitat de Suport a la Recerca Barcelona, Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
- CIBER of Diabetes and Associated Metabolic Diseases (CIBERDEM), Instituto de Salud Carlos III (ISCIII), Barcelona, Spain
| | - Kamlesh Khunti
- Diabetes Research Centre, University of Leicester, Leicester, UK
| | - Dídac Mauricio
- DAP-Cat group, Unitat de Suport a la Recerca Barcelona, Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
- CIBER of Diabetes and Associated Metabolic Diseases (CIBERDEM), Instituto de Salud Carlos III (ISCIII), Barcelona, Spain
- Department of Endocrinology and Nutrition, Hospital Universitari de la Santa Creu i Sant Pau, IIB Sant Pau, Barcelona, Spain
- Department of Medicine, University of Vic-Central University of Catalonia, Vic, Spain
| |
Collapse
|
|
12
|
Te V, Ma S, Por I, Van Damme W, Wouters E, van Olmen J. Diabetes care components effectively implemented in the ASEAN health systems: an umbrella review of systematic reviews. BMJ Open 2023; 13:e071427. [PMID: 37816569 PMCID: PMC10565207 DOI: 10.1136/bmjopen-2022-071427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Accepted: 09/11/2023] [Indexed: 10/12/2023] Open
Abstract
OBJECTIVES Association of Southeast Asian Nations (ASEAN) is among the hardest hit low-income and middle-income countries by diabetes. Innovative Care for Chronic Conditions (ICCC) framework has been adopted by the WHO for health system transformation towards better care for chronic conditions including diabetes. We conducted an umbrella review of systematic reviews on diabetes care components effectively implemented in the ASEAN health systems and map those effective care components into the ICCC framework. DESIGN An umbrella review of systematic reviews and/or meta-analyses following JBI (Joanna Briggs Institute) guidelines. DATA SOURCES Health System Evidence, Health Evidence, PubMed and Ovid MEDLINE. ELIGIBILITY CRITERIA We included systematic reviews and/or meta-analyses which focused on management of type 2 diabetes, reported improvements in measured outcomes and had at least one ASEAN member state in the study setting. DATA EXTRACTION AND SYNTHESIS Two reviewers independently extracted the data and mapped the included studies into the ICCC framework. A narrative synthesis method was used to summarise the findings. The included studies were assessed for methodological quality based on the JBI critical appraisal checklist for systematic reviews and research syntheses. RESULTS 479 records were found of which 36 studies were included for the analysis. A multidisciplinary healthcare team including pharmacists and nurses has been reported to effectively support patients in self-management of their conditions. This can be supported by effective use of digital health interventions. Community health workers either peers or lay people with necessary software (knowledge and skills) and hardware (medical equipment and supplies) can provide complementary care to that of the healthcare staff. CONCLUSION To meet challenges of the increased burden of chronic conditions including diabetes, health policy-makers in the ASEAN member states can consider a paradigm shift in human resources for health towards the multidisciplinary, inclusive, collaborative and complementary team.
Collapse
Affiliation(s)
- Vannarath Te
- School of Public Health, National Institute of Public Health, Phnom Penh, Cambodia
- Health Policy Unit, Department of Public Health, Institute of Tropical Medicine, Antwerpen, Belgium
- Department of Family Medicine and Population Health, University of Antwerp, Antwerpen, Belgium
| | - Sokvy Ma
- School of Public Health, National Institute of Public Health, Phnom Penh, Cambodia
| | - Ir Por
- School of Public Health, National Institute of Public Health, Phnom Penh, Cambodia
- Management Team, National Institute of Public Health, Phnom Penh, Cambodia
| | - Wim Van Damme
- Health Policy Unit, Department of Public Health, Institute of Tropical Medicine, Antwerpen, Belgium
| | - Edwin Wouters
- Department of Sociology, Centre for Population, Family & Health, University of Antwerp, Antwerp, Belgium
- Center for Health Systems Research & Development, University of the Free State, Bloemfontein, South Africa
| | - Josefien van Olmen
- Department of Family Medicine and Population Health, University of Antwerp, Antwerpen, Belgium
| |
Collapse
|
|
13
|
Herman WH, Schillinger D. Rethinking diabetes in the United States. Front Endocrinol (Lausanne) 2023; 14:1185719. [PMID: 37396183 PMCID: PMC10310945 DOI: 10.3389/fendo.2023.1185719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 05/30/2023] [Indexed: 07/04/2023] Open
Abstract
Despite the availability of effective medical treatments, the diabetes epidemic has accelerated in the United States, efforts to translate treatments into routine clinical practice have stalled, and health inequities have persisted. The National Clinical Care Commission (NCCC) was established by the Congress to make recommendations to better leverage federal policies and programs to more effectively prevent and control diabetes and its complications. The NCCC developed a guiding framework that incorporated elements of the Socioecological and Chronic Care Models. It gathered information from both health-related and non-health-related federal agencies, held 12 public meetings, solicited public comments, met with interested parties and key informants, and performed comprehensive literature reviews. The final report of the NCCC was transmitted to the Congress in January 2022. It called for a rethinking of the problem of diabetes in the United States, including the recognition that the lack of progress is due to a failure to confront diabetes as both a complex societal problem as well as a biomedical problem. To prevent and control diabetes, public policies and programs must be aligned to address both social and environmental determinants of health and health care delivery as they impact diabetes. In this article, we discuss the findings and recommendations of the NCCC as they relate to the social and environmental factors that influence the risk of type 2 diabetes and argue that the prevention and control of type 2 diabetes in the U.S. must begin with concrete population-level interventions to address social and environmental determinants of health.
Collapse
Affiliation(s)
- William H. Herman
- Department of Internal Medicine, Division of Metabolism, Endocrinology, and Diabetes, University of Michigan, Ann Arbor, MI, United States
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI, United States
| | - Dean Schillinger
- San Francisco General Hospital, University of California San Francisco School of Medicine, San Francisco, CA, United States
| |
Collapse
|
|
14
|
Zhou J, Sherrill CH, Hwang AY, Lee S. Association between mental health and self-care behavior among older adults with diabetes according to Behavioral Risk Factor Surveillance System 2019. Prim Care Diabetes 2023; 17:250-254. [PMID: 36898951 DOI: 10.1016/j.pcd.2023.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 02/09/2023] [Accepted: 02/26/2023] [Indexed: 03/11/2023]
Abstract
AIM To assess the association of mental health burden with diabetes-related self-care behaviors and healthcare utilization among older adults. METHOD This cross-sectional 2019 Behavioral Risk Factor Surveillance System (BRFSS) study included ≥ 65 years old adults with self-reported diabetes. Three groups were used based on the number of days in the past month affected by mental health: 0 days (no burden), 1-13 days (occasional burden), and 14-30 days (frequent burden). Primary outcome was performing ≥ 3 of 5 diabetes-related self-care behaviors. Secondary outcome was performing ≥ 3 of 5 healthcare utilization behaviors. Multivariable logistic regression was used in Stata/SE 15.1. RESULTS Of 14,217 included individuals, 10.2 % reported frequent mental health burden. Compared to 'no burden', 'occasional' and 'frequent burden' groups included more female, obese, not married persons with younger age of diabetes diagnosis, and reported more comorbidities, insulin use, cost-related barriers to see doctors, and diabetes-related eye issues (p < 0.05). 'Occasional/frequent burden' groups reported less self-care and healthcare utilization behaviors, except 30 % higher healthcare utilization was observed in the 'occasional burden' group compared to no burden (aOR 1.30, 95 %CI 1.08-1.58, p = 0.006). CONCLUSIONS Overall, mental health burden was associated with reduced participation in diabetes-related self-care and healthcare utilization behaviors in a stepwise manner, except occasional burden was associated with higher healthcare utilization.
Collapse
Affiliation(s)
- Jenny Zhou
- University of North Carolina Eshelman School of Pharmacy, 301 Pharmacy Ln, Chapel Hill, NC 27599, United States
| | - Christina H Sherrill
- High Point University Fred Wilson School of Pharmacy, 602 International Ave, High Point, NC 27262, United States
| | - Andrew Y Hwang
- High Point University Fred Wilson School of Pharmacy, 602 International Ave, High Point, NC 27262, United States; MCPHS University School of Pharmacy, 179 Longwood Ave, Boston, MA 02115, United States.
| | - Sun Lee
- High Point University Fred Wilson School of Pharmacy, 602 International Ave, High Point, NC 27262, United States; Analysis Group, 111 Huntington Ave, Boston, MA 02199, United States
| |
Collapse
|
|
15
|
Akan G, Kartal A. The association between Patient Assessment of Chronic Illness Care Scores and quality of life in type 2 diabetes patients. J Res Nurs 2023; 28:199-211. [PMID: 37332311 PMCID: PMC10272694 DOI: 10.1177/17449871221144899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/20/2023] Open
Abstract
Background Chronic illness care is an important factor for health promotion in diabetes since it affects health outcomes such as quality of life. Aims The aim of this study was to investigate the relationship between the Patient Assessment of Chronic Illness Care and the quality of life in type 2 diabetes patients. Methods The study used a cross-sectional and correlational design. The sample included 317 patients with type 2 diabetes. A socio-demographic and disease-related questionnaire form, the Patient Assessment of Chronic Illness Care (PACIC) scale and the WHOQOL-BREF Quality of Life Scale were used to collect data. Results According to the regression analysis, the stronger predictor affecting all domains of quality of life was the overall PACIC. This study demonstrated the importance of satisfaction level of chronic illness care in the improvement of quality of life. Therefore, the factors affecting the satisfaction level with chronic care services should be determined to improve the quality of life of patients. In addition, healthcare based on the chronic-care model should be provided in the care of the patients. Conclusions PACIC had an important effect on quality of life of the patients. This study demonstrated the importance of satisfaction level on chronic illness care in the improvement of quality of life.
Collapse
Affiliation(s)
- Gülçin Akan
- Nurse, Istanbul Başaksehir Çam and Sakura City Hospital, Istanbul, Turkey
| | - Asiye Kartal
- Professor, Public Health Nursing Department, Faculty of Health Sciences, Pamukkale University, Denizli, Turkey
| |
Collapse
|
|
16
|
León-Hernández R, Rodríguez-Pérez AC, Pérez-González YM, de Córdova MIP, de León-Escobedo R, Gómez-Gutiérrez T, Toledano-Toledano F. Psychosocial Factors Associated with Self-Management in Patients with Diabetes. Healthcare (Basel) 2023; 11:healthcare11091284. [PMID: 37174826 PMCID: PMC10178053 DOI: 10.3390/healthcare11091284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 04/26/2023] [Accepted: 04/28/2023] [Indexed: 05/15/2023] Open
Abstract
Despite the significant advances in research on diabetes, relatively few researchers have examined the theoretical and empirical usefulness of explanatory models that contribute to self-management of the disease. In response to the theoretical and empirical approaches related to this topic, the objective of this research was to assess a hypothetical model to explain self-management behavior in patients with type II diabetes through structural equation modeling in a population of users of the services of the State Health Department of Tamaulipas, Mexico. The study used a cross-sectional and explanatory design. The sample was intentional. A total of 183 patients with a diabetes diagnosis completed a sociodemographic data questionnaire, the Partners in Health Scale, the Duke-UNC-11, the Family Apgar, the Self-Efficacy Scale, the Personal Health Questionnaire and the Physical Activity Scale. The results indicated that the hypothetical model was improved by excluding the exercise variable. The appropriate model was used to determine the effects of depression, social support, self-efficacy, family functioning, years of formal education and years with a diagnosis on self-management. The goodness-of-fit indices (GFIs) were good, i.e., χ2/gl = 0.89 (p = 0.529), root mean square error of approximation (RMSEA) = 0.000, and comparative fit index (CFI) = 1.000, with an acceptable degree of parsimony (PNFI = 0.409 and PGFI = 317). The model explained 33.6% of the variance. Therefore, this model represents an important advance in knowledge concerning self-management and provides empirical and theoretical evidence, particularly for the Mexican or Latino population.
Collapse
Affiliation(s)
- Rodrigo León-Hernández
- Consejo Nacional de Ciencia y Tecnología, Av. de los Insurgentes Sur 1582, Crédito Constructor, Benito Juárez, Mexico City 03940, Mexico
| | - Andrea C Rodríguez-Pérez
- Facultad de Enfermería Tampico, Universidad Autónoma de Tamaulipas, Adolfo López Mateos S/N, Universidad, Tampico, Tamaulipas 89109, Mexico
| | - Yessica M Pérez-González
- Facultad de Enfermería Tampico, Universidad Autónoma de Tamaulipas, Adolfo López Mateos S/N, Universidad, Tampico, Tamaulipas 89109, Mexico
| | - María I P de Córdova
- Facultad de Enfermería Tampico, Universidad Autónoma de Tamaulipas, Adolfo López Mateos S/N, Universidad, Tampico, Tamaulipas 89109, Mexico
| | - Raúl de León-Escobedo
- Facultad de Medicina de Tampico, "Dr. Alberto Romo Caballero" Universidad Autónoma de Tamaulipas, Tamaulipas 89000, Mexico
| | - Tranquilina Gómez-Gutiérrez
- Facultad de Enfermería Tampico, Universidad Autónoma de Tamaulipas, Adolfo López Mateos S/N, Universidad, Tampico, Tamaulipas 89109, Mexico
| | - Filiberto Toledano-Toledano
- Unidad de Investigación en Medicina Basada en Evidencias, Hospital Infantil de México Federico Gómez Instituto Nacional de Salud, Dr. Márquez 162, Doctores, Cuauhtémoc, Mexico City 06720, Mexico
- Unidad de Investigación Multidisciplinaria en Salud, Instituto Nacional de Rehabilitación Luis Guillermo Ibarra Ibarra, Calzada México-Xochimilco 289, Arenal de Guadalupe, Tlalpan, Mexico City 14389, Mexico
- Dirección de Investigación y Diseminación del Conocimiento, Instituto Nacional de Ciencias e Innovación para la Formación de Comunidad Científica, INDEHUS, Periférico Sur 4860, Arenal de Guadalupe, Tlalpan, Mexico City 14389, Mexico
| |
Collapse
|
|
17
|
Pedroni C, Djuric O, Bassi MC, Mione L, Caleffi D, Testa G, Prandi C, Navazio A, Giorgi Rossi P. Elements Characterising Multicomponent Interventions Used to Improve Disease Management Models and Clinical Pathways in Acute and Chronic Heart Failure: A Scoping Review. Healthcare (Basel) 2023; 11:1227. [PMID: 37174769 PMCID: PMC10178532 DOI: 10.3390/healthcare11091227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 04/17/2023] [Accepted: 04/23/2023] [Indexed: 05/15/2023] Open
Abstract
This study aimed to summarise different interventions used to improve clinical models and pathways in the management of chronic and acute heart failure (HF). A scoping review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement. MEDLINE (via PubMed), Embase, The Cochrane Library, and CINAHL were searched for systematic reviews (SR) published in the period from 2014 to 2019 in the English language. Primary articles cited in SR that fulfil inclusion and exclusion criteria were extracted and examined using narrative synthesis. Interventions were classified based on five chosen elements of the Chronic Care Model (CCM) framework (self-management support, decision support, community resources and policies, delivery system, and clinical information system). Out of 155 SRs retrieved, 7 were considered for the extraction of 166 primary articles. The prevailing setting was the patient's home. Only 46 studies specified the severity of HF by reporting the level of left ventricular ejection fraction (LVEF) impairment in a heterogeneous manner. However, most studies targeted the populations with LVEF ≤ 45% and LVEF < 40%. Self-management and delivery systems were the most evaluated CCM elements. Interventions related to community resources and policy and advising/reminding systems for providers were rarely evaluated. No studies addressed the implementation of a disease registry. A multidisciplinary team was available with similarly low frequency in each setting. Although HF care should be a multi-component model, most studies did not analyse the role of some important components, such as the decision support tools to disseminate guidelines and program planning that includes measurable targets.
Collapse
Affiliation(s)
- Cristina Pedroni
- Direzione delle Professioni Sanitarie, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, 42122 Reggio Emilia, Italy;
- Laurea Magistrale in Scienze Infermieristiche e Ostetriche, University of Modena and Reggio Emilia, 42122 Reggio Emilia, Italy;
| | - Olivera Djuric
- Epidemiology Unit, Azienda Unità Sanitaria Locale–IRCCS di Reggio Emilia, 42122 Reggio Emilia, Italy;
- Centre for Environmental, Nutritional and Genetic Epidemiology (CREAGEN), Section of Public Health, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, 41125 Modena, Italy
| | - Maria Chiara Bassi
- Medical Library, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy;
| | - Lorenzo Mione
- Laurea Magistrale in Scienze Infermieristiche e Ostetriche, University of Modena and Reggio Emilia, 42122 Reggio Emilia, Italy;
| | - Dalia Caleffi
- Cardiology Division, Azienda Ospedaliera Universitaria di Modena, 41124 Modena, Italy;
| | - Giacomo Testa
- UO Medicina, Ospedale Giuseppe Dossetti, Azienda Unità Sanitaria Locale di Bologna, 40053 Bologna, Italy;
| | - Cesarina Prandi
- Department of Business Economics, Health & Social Care, University of Applied Sciences & Arts of Southern Switzerland, CH-6928 Manno, Switzerland;
| | - Alessandro Navazio
- Cardiology Division, Arcispedale Santa Maria Nuova, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy;
| | - Paolo Giorgi Rossi
- Epidemiology Unit, Azienda Unità Sanitaria Locale–IRCCS di Reggio Emilia, 42122 Reggio Emilia, Italy;
| |
Collapse
|
|
18
|
Alotaibi YK, Al-Nowaiser N, Al Harbi TJ, Tourkmani AM, Moharram M. Improving type 2 diabetes mellitus management in Ministry of Defense Hospitals in the Kingdom of Saudi Arabia 2018-2021. BMJ Open Qual 2023; 12:bmjoq-2022-002037. [PMID: 37012002 PMCID: PMC10083884 DOI: 10.1136/bmjoq-2022-002037] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Accepted: 02/18/2023] [Indexed: 04/05/2023] Open
Abstract
Diabetes mellitus is a metabolic disease characterised by elevated levels of blood glucose and is a leading cause of disability and mortality. Uncontrolled type 2 diabetes leads to complications such as retinopathy, nephropathy and neuropathy. Improved treatment of hyperglycaemia is likely to delay the onset and progression of microvascular and neuropathic complications.This article describes the efforts of 18 governmental hospitals in the Kingdom of Saudi Arabia that enrolled in a collaborative improvement project to improve the poor glycaemic control (HbA1c >9% to be less than 15%) of patients with diabetes by the end of 2021 among all the chronic illness clinics in the enrolled military hospitals. Enrolled hospitals were required to implement an evidence-based change package that included the implementation of diabetes clinical practice guidelines with standardised assessment and care planning tools. Furthermore, care delivery was standardised using a standard clinic scope of service that focused on multidisciplinary care teams. Finally, hospitals were required to implement diabetes registries that were used by case managers for poorly controlled patients.The project timetable was from October 2018 to December 2021. Diabetes poor control (HbA1c >9%) showed improved mean difference of 12.7% (34.9% baseline, 22.2% after) with a p value of 0.01. Diabetes optimal testing significantly improved from 41% at the start of the project in the fourth quarter of 2018, reaching 78% by the end of the fourth quarter of 2021. Variation between hospitals showed a significant reduction in the first quarter of 2021.The collaborative multilevel approach of standardising the care based on the best available evidence through policies, guidelines and protocols, patient-focused care and integrated care plan by a multidisciplinary team was associated with noticeable improvement in all key performance indicators of the project.
Collapse
Affiliation(s)
- Yasser K Alotaibi
- Continuous Quality Improvement and Patient Safety, General Directorate for Health Services, Ministry of Defense, Riyadh, Saudi Arabia
| | - Noura Al-Nowaiser
- Continuous Quality Improvement and Patient Safety, General Directorate for Health Services, Ministry of Defense, Riyadh, Saudi Arabia
| | - Turki J Al Harbi
- Chronic Illness Center, Family and Community Medicine Department, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Ayla M Tourkmani
- Chronic Illness Center, Family and Community Medicine Department, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Maha Moharram
- Continuous Quality Improvement and Patient Safety, General Directorate for Health Services, Ministry of Defense, Riyadh, Saudi Arabia
| |
Collapse
|
|
19
|
Blanchette V, Armstrong DG, Drudi L, Rizzo M. Upstream comprehensive management of individuals with diabetes with multimorbidity and frailty to act against amputation. J Diabetes Complications 2023; 37:108407. [PMID: 36738597 DOI: 10.1016/j.jdiacomp.2023.108407] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Accepted: 01/21/2023] [Indexed: 01/31/2023]
Abstract
This manuscript constitutes a commentary on: "Retrospective cohort study of long-term outcomes and prognostic factors for survival after lower extremity amputation in patients with diabetes" by Vuorlaakso et al. (2023). We aim to contribute to the reflection of their findings to support the comprehensive management of vulnerable individuals with multimorbidity and/frailty for limb preservation. There is an urgent need to understand the effects of frailty on overall survival after amputation, survival without major amputation, and the effect modification with multimorbidity.
Collapse
Affiliation(s)
- Virginie Blanchette
- Department of Human Kinetics and Podiatric Medicine, Université du Québec à Trois-Rivières, Trois-Rivières G8Z 4M3, Canada; VITAM - Sustainable Health Research Centre, Québec, Québec G1J 2G1, Canada; Centre de recherche du CISSS de Chaudière-Appalaches, Lévis G6V 3Z1, Canada.
| | - David G Armstrong
- Southwestern Academic Limb Salvage Alliance (SALSA), Department of Surgery, Keck School of Medicine of University of Southern California, Los Angeles, CA 90033, United States
| | - Laura Drudi
- Division of Vascular Surgery, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, QC, Canada; Innovation Hub, Centre de Rercherche du CHUM, Montreal, QC, Canada
| | - Manfredi Rizzo
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, School of Medicine, University of Palermo, Italy
| |
Collapse
|
|
20
|
Shao Y, Stoecker C, Hong D, Nauman E, Fonseca V, Hu G, Bazzano AN, Fort D, Kabagambe EK, Shi L. The Impact of Reimbursement for Non-Face-to-Face Chronic Care Management on Comprehensive Metabolic Biomarkers Among Multimorbid Patients With Type 2 Diabetes. Med Care 2023; 61:157-164. [PMID: 36728398 PMCID: PMC11110110 DOI: 10.1097/mlr.0000000000001816] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
AIMS We evaluated the impact of reimbursement for non-face-to-face chronic care management (NFFCCM) on comprehensive metabolic risk factors among multimorbid Medicare beneficiaries with type 2 diabetes in Louisiana. MATERIALS AND METHODS We implemented a propensity score method to obtain comparable treatment (n=1501 with NFFCCM) and control (n=17,524 without NFFCCM) groups. Patients with type 2 diabetes were extracted from the electronic health records stored in REACHnet. The study period was from 2013 to February 2020. The comprehensive metabolic risk factors included the primary outcome of glycated hemoglobin (HbA1c) (as the primary outcome) and the secondary outcomes of body mass index (BMI), systolic blood pressure (BP), and low-density lipoprotein cholesterol. RESULTS Receiving any NFFCCM was associated with improvement in all outcomes measures: a reduction in HbA1c of 0.063% (95% CI: 0.031%-0.094%; P <0.001), a reduction in BMI of 0.155 kg/m 2 (95% CI: 0.029-0.282 kg/m 2 ; P =0.016), a reduction in systolic BP of 0.816 mm Hg (95% CI: 0.469-1.163 mm Hg; P <0.001), and a reduction in low-density lipoprotein cholesterol of 1.779 mg/dL (95% CI: 0.988 2.570 mg/dL; P <0.001). Compared with the control group, the treatment group had 1.6% more patients with HbA1c <7% (95% CI: 0.3%-2.9%; P =0.013). CONCLUSIONS Patients with diabetes in Louisiana receiving NFFCCM experienced better control of HbA1c, BMI, BP, and low-density lipoprotein outcomes.
Collapse
Affiliation(s)
- Yixue Shao
- Department of Health Policy and Management, School of Public Health and Tropical Medicine, Tulane University
| | - Charles Stoecker
- Department of Health Policy and Management, School of Public Health and Tropical Medicine, Tulane University
| | - Dongzhe Hong
- Department of Health Policy and Management, School of Public Health and Tropical Medicine, Tulane University
| | | | - Vivian Fonseca
- Section of Endocrinology, Tulane University Health Sciences Center, New Orleans
| | - Gang Hu
- Pennington Biomedical Research Center, Baton Rouge
| | - Alessandra N. Bazzano
- Department of Social, Behavioral, and Population Sciences, School of Public Health and Tropical Medicine, Tulane University
| | | | | | - Lizheng Shi
- Department of Health Policy and Management, School of Public Health and Tropical Medicine, Tulane University
| |
Collapse
|
|
21
|
Danhieux K, Buffel V, Remmen R, Wouters E, van Olmen J. Scale-up of a chronic care model-based programme for type 2 diabetes in Belgium: a mixed-methods study. BMC Health Serv Res 2023; 23:141. [PMID: 36759890 PMCID: PMC9911183 DOI: 10.1186/s12913-023-09115-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 01/27/2023] [Indexed: 02/11/2023] Open
Abstract
BACKGROUND Type 2 diabetes (T2D) is an increasingly dominant disease. Interventions are more effective when carried out by a prepared and proactive team within an organised system - the integrated care (IC) model. The Chronic Care Model (CCM) provides guidance for its implementation, but scale-up of IC is challenging, and this hampers outcomes for T2D care. In this paper, we used the CCM to investigate the current implementation of IC in primary care in Flanders (Belgium) and its variability in different practice types. METHODS Belgium contains three different primary-care practice types: monodisciplinary fee-for-service practices, multidisciplinary fee-for-service practices and multidisciplinary capitation-based practices. Disproportional sampling was used to select a maximum of 10 practices for each type in three Flemish regions, leading to a total of 66 practices. The study employed a mixed methods design whereby the Assessment of Chronic Illness Care (ACIC) was complemented with interviews with general practitioners, nurses and dieticians linked to the 66 practices. RESULTS The ACIC scores of the fee-for-service practices - containing 97% of Belgian patients - only corresponded to basic support for chronic illness care for T2D. Multidisciplinary and capitation-based practices scored considerably higher than traditional monodisciplinary fee-for-service practices. The region had no significant impact on the ACIC scores. Having a nurse, being a capitation practice and having a secretary had a significant effect in the regression analysis, which explained 75% of the variance in ACIC scores. Better-performing practices were successful due to clear role-defining, task delegation to the nurse, coordination, structured use of the electronic medical record, planning of consultations and integration of self-management support, and behaviour-change intervention (internally or using community initiatives). The longer nurses work in primary care practices, the higher the chance that they perform more advanced tasks. CONCLUSIONS Besides the presence of a nurse or secretary, also working multidisciplinary under one roof and a capitation-based financing system are important features of a system wherein IC for T2D can be scaled-up successfully. Belgian policymakers should rethink the role of paramedics in primary care and make the financing system more integrated. As the scale-up of the IC varied highly in different contexts, uniform roll-out across a health system containing multiple types of practices may not be successful.
Collapse
Affiliation(s)
- Katrien Danhieux
- Family Medicine and Population Health, University of Antwerp, Antwerp, Belgium.
- Institute of Tropical Medicine Antwerp, Antwerp, Belgium.
| | - Veerle Buffel
- Center for Population, Family and Health, University of Antwerp, Antwerp, Belgium
| | - Roy Remmen
- Family Medicine and Population Health, University of Antwerp, Antwerp, Belgium
| | - Edwin Wouters
- Center for Population, Family and Health, University of Antwerp, Antwerp, Belgium
| | - Josefien van Olmen
- Family Medicine and Population Health, University of Antwerp, Antwerp, Belgium
- Institute of Tropical Medicine Antwerp, Antwerp, Belgium
| |
Collapse
|
|
22
|
Herman WH, Bullock A, Boltri JM, Conlin PR, Greenlee MC, Lopata AM, Powell C, Tracer H, Schillinger D. The National Clinical Care Commission Report to Congress: Background, Methods, and Foundational Recommendations. Diabetes Care 2023; 46:e14-e23. [PMID: 36701594 PMCID: PMC9887619 DOI: 10.2337/dc22-0611] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 11/01/2022] [Indexed: 01/27/2023]
Abstract
Since the first Federal Commission on Diabetes issued its report in 1975, the diabetes epidemic in the U.S. has accelerated, and efforts to translate advances in diabetes treatment into routine clinical practice have stalled. In 2021, the National Clinical Care Commission (NCCC) delivered a report to Congress that provided recommendations to leverage federal policies and programs to more effectively prevent and treat diabetes and its complications. In the five articles in this series, we present the NCCC's evidence-based recommendations to 1) reduce diabetes-related risks, prevent type 2 diabetes, and avert diabetes complications through changes in federal policies and programs affecting the general population; 2) prevent type 2 diabetes in at-risk individuals through targeted lifestyle and medication interventions; and 3) improve the treatment of diabetes and its complications to improve the health outcomes of people with diabetes. In this first article, we review the successes and limitations of previous federal efforts to combat diabetes. We then describe the establishment of and charge to the NCCC. We discuss the development of a hybrid conceptual model that guided the NCCC's novel all-of-government approach to address diabetes as both a societal and medical problem. We then review the procedures used by the NCCC to gather information from federal agencies, stakeholders, key informants, and the public and to conduct literature reviews. Finally, we review the NCCC's three foundational recommendations: 1) improve the coordination of non-health-related and health-related federal agencies to address the social and environmental conditions that are accelerating the diabetes epidemic; 2) ensure that all Americans at risk for and with diabetes have health insurance and access to health care; and 3) ensure that all federal policies and programs promote health equity in diabetes.
Collapse
Affiliation(s)
| | - Ann Bullock
- Division of Diabetes Treatment and Prevention, Indian Health Service, Rockville, MD
| | | | - Paul R. Conlin
- Department of Veterans Affairs Boston Healthcare System, Boston, MA
- Harvard Medical School, Boston, MA
| | | | - Aaron M. Lopata
- Maternal and Child Health Bureau, Health Resources and Services Administration, Rockville, MD
| | - Clydette Powell
- School of Medicine and Health Services, George Washington University, Washington, DC
| | - Howard Tracer
- Agency for Healthcare Research and Quality, Department of Health and Human Services, Rockville, MD
| | - Dean Schillinger
- University of California San Francisco School of Medicine and San Francisco General Hospital, San Francisco, CA
| |
Collapse
|
|
23
|
Boocha K, Ploylearmsang C. Development and Implementation of Diabetes Care by a Community Network Based on a Chronic Care Model. J Prim Care Community Health 2023; 14:21501319231181874. [PMID: 37366173 DOI: 10.1177/21501319231181874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/28/2023] Open
Abstract
INTRODUCTION This participatory action research was conducted by the collaborative health-related team in a district, in Thailand. The community network jointly developed a care model for diabetic patients in primary care using the Chronic Care Model (CCM) and evaluated the effectiveness of implemented model. METHODS Data was collected between October 2021 and March 2022 and involved 2 groups: 1) a community network of 25 people including representatives of the community hospital, primary care hospital, Sub-district administrative organization, community leaders, community representatives, representatives of diabetic patients, and representatives of caregivers of diabetic patients, and 2) 41 people with type 2 diabetes and 41 of their family caregivers. The research was conducted in 4 stages: planning, action, observation, and reflection. RESULTS Both quantitative and qualitative data were collected, and the overall average knowledge scores of diabetic patients, family caregivers, and community representatives significantly increased from before (6.07 ± 2.11, 7.07 ± 1.98, P = .024, 5.74 ± 1.88, 7.37 ± 2.25, P < .001, 7.47 ± 2.44, 8.99 ± 1.72, P = .010) respectively. For satisfaction, diabetic patients were most satisfied with family caregiver support, while the community network representatives were most satisfied with their participation in planning a model for diabetic patients in primary care. After model implementation, the blood sugar-controlled patients (HbA1c < 7 mg%) significantly increased (0 and 9.76%, P = .045), although the fasting blood sugar (FBS) of diabetic patients did not improve. CONCLUSION The development and implementation of diabetes care based on CCM, promoted community participation and involvement in diabetes care. This model mainly affected diabetic patients who could control their HbA1c level and the satisfaction of the community network.
Collapse
Affiliation(s)
- Kanniyaporn Boocha
- Master degree student of Primary Care Pharmacy Program, Faculty of Pharmacy, Mahasarakham University, Katarawichai, Maha Sarakham, Thailand
| | | |
Collapse
|
|
24
|
Goh LH, Siah CJR, Tam WWS, Tai ES, Young DYL. Effectiveness of the chronic care model for adults with type 2 diabetes in primary care: a systematic review and meta-analysis. Syst Rev 2022; 11:273. [PMID: 36522687 PMCID: PMC9753411 DOI: 10.1186/s13643-022-02117-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 11/02/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Mixed evidence exists regarding the effectiveness of the Chronic Care Model (CCM) with patient outcomes. The aim of this review is to examine the effectiveness of CCM interventions on hemoglobin A1c (HbA1c), systolic BP (SBP), diastolic BP (DBP), LDL cholesterol and body mass index (BMI) among primary care adults with type 2 diabetes. METHODS PubMed, Embase, CINAHL, Cochrane Central Registry of Controlled Trials, Scopus and Web of Science were searched from January 1990 to June 2021 for randomized controlled trials (RCTs) comparing CCM interventions against usual care among adults with type 2 diabetes mellitus in primary care with HbA1c, SBP, DBP, LDL cholesterol and BMI as outcomes. An abbreviated search was performed from 2021 to April 2022. This study followed the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines for data extraction and Cochrane risk of bias assessment. Two reviewers independently extracted the data. Meta-analysis was performed using Review Manager software. Heterogeneity was evaluated using χ2 and I2 test statistics. Overall effects were evaluated using Z statistic. RESULTS A total of 17 studies involving 16485 patients were identified. Most studies had low risks of bias. Meta-analysis of all 17 studies revealed that CCM interventions significantly decreased HbA1c levels compared to usual care, with a mean difference (MD) of -0.21%, 95% CI -0.30, -0.13; Z = 5.07, p<0.00001. Larger effects were experienced among adults with baseline HbA1c ≥8% (MD -0.36%, 95% CI -0.51, -0.21; Z = 5.05, p<0.00001) and when four or more CCM elements were present in the interventions (MD -0.25%, 95% CI -0.35, -0.15; Z = 4.85, p<0.00001). Interventions with CCM decreased SBP (MD -2.93 mmHg, 95% CI -4.46, -1.40, Z = 3.75, p=0.0002) and DBP (MD -1.35 mmHg, 95% CI -2.05, -0.65, Z = 3.79, p=0.0002) compared to usual care but there was no impact on LDL cholesterol levels or BMI. CONCLUSIONS CCM interventions, compared to usual care, improve glycaemic control among adults with type 2 diabetes in primary care, with greater reductions when the mean baseline HbA1c is ≥8% and with interventions containing four or more CCM elements. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42021273959.
Collapse
Affiliation(s)
- Lay Hoon Goh
- Division of Family Medicine, Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block Level 9, 1E Kent Ridge Road, Singapore, 119228 Singapore
| | - Chiew Jiat Rosalind Siah
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Wilson Wai San Tam
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - E Shyong Tai
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Doris Yee Ling Young
- Division of Family Medicine, Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block Level 9, 1E Kent Ridge Road, Singapore, 119228 Singapore
| |
Collapse
|
|
25
|
Buffel V, Danhieux K, Bos P, Remmen R, Van Olmen J, Wouters E. Development and operationalization of a data framework to assess quality of integrated diabetes care in the fragmented data landscape of Belgium. BMC Health Serv Res 2022; 22:1257. [PMID: 36253775 PMCID: PMC9578257 DOI: 10.1186/s12913-022-08625-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 09/30/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND To assess the quality of integrated diabetes care, we should be able to follow the patient throughout the care path, monitor his/her care process and link them to his/her health outcomes, while simultaneously link this information to the primary care system and its performance on the structure and organization related quality indicators. However the development process of such a data framework is challenging, even in period of increasing and improving health data storage and management. This study aims to develop an integrated multi-level data framework for quality of diabetes care and to operationalize this framework in the fragmented Belgium health care and data landscape. METHODS Based on document reviews, iterative working group discussions and expert consultations, theoretical approaches and quality indicators were identified and assessed. After mapping and assessing the validity of existing health information systems and available data sources through expert consultations, the theoretical framework was translated in a data framework with measurable quality indicators. The construction of the data base included sampling procedures, data-collection, and several technical and privacy-related aspects of linking and accessing Belgian datasets. RESULTS To address three dimensions of quality of care, we integrated the chronic care model and cascade of care approach, addressing respectively the structure related quality indicators and the process and outcome related indicators. The corresponding data framework is based on self-collected data at the primary care practice level (using the Assessment of quality of integrated care tool), and linked health insurance data with lab data at the patient level. CONCLUSION In this study, we have described the transition of a theoretical quality of care framework to a unique multilevel database, which allows assessing the quality of diabetes care, by considering the complete care continuum (process and outcomes) as well as organizational characteristics of primary care practices.
Collapse
Affiliation(s)
- Veerle Buffel
- Department of Sociology, University of Antwerp, Antwerp, Belgium.
| | - Katrien Danhieux
- Department of family medicine and population health, University of Antwerp, Antwerp, Belgium
| | - Philippe Bos
- Department of Sociology, University of Antwerp, Antwerp, Belgium
| | - Roy Remmen
- Department of family medicine and population health, University of Antwerp, Antwerp, Belgium
| | - Josefien Van Olmen
- Department of family medicine and population health, University of Antwerp, Antwerp, Belgium
| | - Edwin Wouters
- Department of Sociology, University of Antwerp, Antwerp, Belgium
| |
Collapse
|
|
26
|
Egede LE, Ozieh MN, Campbell JA, Williams JS, Walker RJ. Cross-Sector Collaborations Between Health Care Systems and Community Partners That Target Health Equity/Disparities in Diabetes Care. Diabetes Spectr 2022; 35:313-319. [PMID: 36082007 PMCID: PMC9396714 DOI: 10.2337/dsi22-0001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Evidence shows that social determinants of health (SDOH) are key drivers of diabetes outcomes and disparities in diabetes care. Targeting SDOH at the individual, organizational, and policy levels is an essential step in improving health equity for individuals living with diabetes. In addition, there is increasing recognition of the need to build collaboration across the health care system and the communities experiencing inequities to improve health equity. As a result, partnerships between health and nonhealth sectors have emerged as a crucial component for increasing health equity in diabetes care and achieving health equity. The purpose of this article is to discuss cross-sector collaborations between health care systems and nonhealth partners that target health equity in diabetes care.
Collapse
Affiliation(s)
- Leonard E. Egede
- Department of Medicine, Division of General Internal Medicine, Medical College of Wisconsin, Milwaukee, WI
- Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI
| | - Mukoso N. Ozieh
- Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI
- Department of Medicine, Division of Nephrology, Medical College of Wisconsin, Milwaukee, WI
- Division of Nephrology, Clement J. Zablocki VA Medical Center, Milwaukee, WI
| | - Jennifer A. Campbell
- Department of Medicine, Division of General Internal Medicine, Medical College of Wisconsin, Milwaukee, WI
- Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI
| | - Joni S. Williams
- Department of Medicine, Division of General Internal Medicine, Medical College of Wisconsin, Milwaukee, WI
- Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI
| | - Rebekah J. Walker
- Department of Medicine, Division of General Internal Medicine, Medical College of Wisconsin, Milwaukee, WI
- Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI
| |
Collapse
|
|
27
|
Molayaghobi NS, Abazari P, Taleghani F, Iraj B. Lived Experiences of Diabetes Team and Patients about Diabetes Care System after Redesigning Delivery System and Supporting Self-Management in Iran: A Qualitative Research. Int J Prev Med 2022; 13:85. [PMID: 35958364 PMCID: PMC9362745 DOI: 10.4103/ijpvm.ijpvm_238_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 11/27/2020] [Indexed: 11/13/2022] Open
Abstract
Background Diabetes as a chronic disease requires a change in the paradigm of treatment and health care system based on acute illnesses to chronic conditions. Chronic Care Model has been designed to address this need. This study aimed to explore the lived experiences of the diabetes team and diabetic patients regarding the health care system after redesigning delivery system and supporting self-management based on the Chronic Care Model in Iran. Methods Research was conducted with a qualitative descriptive approach in one of the Isfahan city clinics in 2018. The participants were diabetes team (composed of diabetes physician, nurse, assistant nurse and dean of the clinic) and 17 type- 2 diabetic patients who were selected through purposive sampling. Data collection was performed through semi-structured interviews and then were analyzed using content analysis with an inductive approach. Results The findings of this study were composed of the following two main categories: (1) educational function change, including the sub-categories of evidence-based nurse education and patients' demand to ongoing participation in the training classes; and (2) treatment and care method upgrade, including the sub-categories of nurse's role change in a team approach, continuity in cares and upgrading patients' self-care behaviors. Conclusions Delivery system redesign and diabetes self-management support based on Chronic Care Model changed organizational structure and performance of the diabetes care system. It also reformed the structure of treatment providers from a vertical and hierarchical form to a team arrangement. Nurse's educational function became evidence-based and patients' self-care behaviors upgraded.
Collapse
Affiliation(s)
| | - Parvaneh Abazari
- Department of Nursing, Najafabad Branch Islamic Azad University, Najafabad, Iran
| | - Fariba Taleghani
- RN, Professor, MSN, BSN, Nursing and Midwifery Care Research Center, Faculty of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Bijan Iraj
- Associate Professor of Endocrinology, Isfahan Endocrine and Metabolism Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| |
Collapse
|
|
28
|
Barriers to accessing diabetes specialty care for persons with lived experience of homelessness in Canada. Can J Diabetes 2022; 46:594-601.e2. [DOI: 10.1016/j.jcjd.2022.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 04/25/2022] [Accepted: 05/19/2022] [Indexed: 11/18/2022]
|
|
29
|
Conlin PR, Greenlee C, Schillinger D, Lopata A, Boltri JM, Tracer H, Albright A, Bullock A, Herman WH. The National Clinical Care Commission Report: Improving Federal Programs That Impact Diabetes Prevention and Care. Ann Intern Med 2022; 175:594-597. [PMID: 35157491 PMCID: PMC9029008 DOI: 10.7326/m21-4175] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
| | - Paul R Conlin
- Department of Veterans Affairs Boston Healthcare System, Boston, Massachusetts
| | | | - Dean Schillinger
- University of California, San Francisco, School of Medicine, San Francisco General Hospital, San Francisco, California
| | - Aaron Lopata
- Maternal and Child Health Bureau, Office of the Associate Administrator, Health Resources and Services Administration, Department of Health and Human Services, Rockville, Maryland
| | - John M Boltri
- Department of Family and Community Medicine, Northeast Ohio Medical University College of Medicine, Rootstown, Ohio
| | - Howard Tracer
- Center for Evidence and Practice Improvement, Agency for Healthcare Research and Quality, Department of Health and Human Services, Rockville, Maryland
| | - Ann Albright
- Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Department of Health and Human Services, Atlanta, Georgia
| | - Ann Bullock
- Indian Health Service, Department of Health and Human Services, Rockville, Maryland
| | | |
Collapse
|
|
30
|
Almomani MH, AL-Tawalbeh S. Glycemic Control and Its Relationship with Diabetes Self-Care Behaviors Among Patients with Type 2 Diabetes in Northern Jordan: A Cross-Sectional Study. Patient Prefer Adherence 2022; 16:449-465. [PMID: 35221675 PMCID: PMC8865859 DOI: 10.2147/ppa.s343214] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Accepted: 01/15/2022] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Type 2 diabetes mellitus (T2DM) is a chronic progressive disease that significantly impacts morbidity and mortality worldwide. Glycemic control is central in diabetes management, yet complex and challenging to achieve; it can be affected by various factors. Diabetes self-care behaviors are vital strategies for effective T2DM management. PURPOSE To evaluate the levels of glycemic control and diabetes self-care behaviors, and the significance of each behavior on glycemic control among patients with T2DM in Jordan. PATIENTS AND METHODS This cross-sectional study was conducted in medical and endocrinology outpatient clinics of three hospitals in northern Jordan. A convenience sample of 520 patients with T2DM participated in the study. Diabetes self-care behaviors, including diet, exercise, blood glucose testing, taking medication, and foot care behaviors, were measured using the Arabic version of the Summary of Diabetes Self-Care Activities (SDSCA-Arabic) questionnaire. Psychological distress was measured using the Arabic version of the 4-items Patient Health Questionnaire (PHQ-4). Glycated hemoglobin (HbA1c) levels were used to assess glycemic control. RESULTS Out of 520 participants, 92.7% (n= 482) had poor glycemic control (HbA1c ≥7%), with a mean of 9.29% (SD=2.06) for HbA1c. The SDSCA overall mean score was 3.25 days (SD=0.88), indicating an unsatisfactory level, with 79.2% of participants having performed self-care activities 4-days/week. Greater adherence to diabetes self-care behaviors was associated with better glycemic control. Exercise was the most important predictor of HbA1c (p<0.001), followed by general diet (p<0.001), specific diet (p<0.001), and blood sugar testing (p<0.001). Moreover, the Body Mass Index (p<0.001), treatment type (p<0.001), and income (p=0.03) were significant predictors. CONCLUSION The proportions of poor glycemic control and unsatisfactory self-care behaviors were high among T2DM patients. To enhance patients' self-care behaviors and lifestyles changes, the patients need tailored diabetes self-care management educational and supportive programs, conducted by qualified diabetes educators using culturally sensitive strategies.
Collapse
Affiliation(s)
- Maysa H Almomani
- Department of Adult Health Nursing, Faculty of Nursing, Jordan University of Science and Technology, Irbid, Jordan
- Correspondence: Maysa H Almomani, Tel +962 2 7201000 Ext 26176, Fax +962 2 7201065, Email
| | - Shahinaz AL-Tawalbeh
- Department of Community and Mental Health Nursing, Faculty of Nursing, Jordan University of Science and Technology, Irbid, Jordan
| |
Collapse
|
|
31
|
Lim S, Wyatt LC, Mammen S, Zanowiak JM, Mohaimin S, Troxel AB, Lindau ST, Gold HT, Shelley D, Trinh-Shevrin C, Islam NS. Implementation of a multi-level community-clinical linkage intervention to improve glycemic control among south Asian patients with uncontrolled diabetes: study protocol of the DREAM initiative. BMC Endocr Disord 2021; 21:233. [PMID: 34814899 PMCID: PMC8609264 DOI: 10.1186/s12902-021-00885-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 10/22/2021] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND A number of studies have identified patient-, provider-, and community-level barriers to effective diabetes management among South Asian Americans, who have a high prevalence of type 2 diabetes. However, no multi-level, integrated community health worker (CHW) models leveraging health information technology (HIT) have been developed to mitigate disease among this population. This paper describes the protocol for a multi-level, community-clinical linkage intervention to improve glycemic control among South Asians with uncontrolled diabetes. METHODS The study includes three components: 1) building the capacity of primary care practices (PCPs) to utilize electronic health record (EHR) registries to identify patients with uncontrolled diabetes; 2) delivery of a culturally- and linguistically-adapted CHW intervention to improve diabetes self-management; and 3) HIT-enabled linkage to culturally-relevant community resources. The CHW intervention component includes a randomized controlled trial consisting of group education sessions on diabetes management, physical activity, and diet/nutrition. South Asian individuals with type 2 diabetes are recruited from 20 PCPs throughout NYC and randomized at the individual level within each PCP site. A total of 886 individuals will be randomized into treatment or control groups; EHR data collection occurs at screening, 6-, 12-, and 18-month. We hypothesize that individuals receiving the multi-level diabetes management intervention will be 15% more likely than the control group to achieve ≥0.5% point reduction in hemoglobin A1c (HbA1c) at 6-months. Secondary outcomes include change in weight, body mass index, and LDL cholesterol; the increased use of community and social services; and increased health self-efficacy. Additionally, a cost-effectiveness analysis will focus on implementation and healthcare utilization costs to determine the incremental cost per person achieving an HbA1c change of ≥0.5%. DISCUSSION Final outcomes will provide evidence regarding the effectiveness of a multi-level, integrated EHR-CHW intervention, implemented in small PCP settings to promote diabetes control among an underserved South Asian population. The study leverages multisectoral partnerships, including the local health department, a healthcare payer, and EHR vendors. Study findings will have important implications for the translation of integrated evidence-based strategies to other minority communities and in under-resourced primary care settings. TRIAL REGISTRATION This study was registered with clinicaltrials.gov: NCT03333044 on November 6, 2017.
Collapse
Affiliation(s)
- Sahnah Lim
- Department of Population Health, NYU Grossman School of Medicine, 180 Madison Avenue, New York, NY, 10016, USA.
| | - Laura C Wyatt
- Department of Population Health, NYU Grossman School of Medicine, 180 Madison Avenue, New York, NY, 10016, USA
| | - Shinu Mammen
- Department of Population Health, NYU Grossman School of Medicine, 180 Madison Avenue, New York, NY, 10016, USA
| | - Jennifer M Zanowiak
- Department of Population Health, NYU Grossman School of Medicine, 180 Madison Avenue, New York, NY, 10016, USA
| | - Sadia Mohaimin
- Department of Population Health, NYU Grossman School of Medicine, 180 Madison Avenue, New York, NY, 10016, USA
| | - Andrea B Troxel
- Department of Population Health, NYU Grossman School of Medicine, 180 Madison Avenue, New York, NY, 10016, USA
| | - Stacy Tessler Lindau
- Departments of Obstetrics and Gynecology and Medicine-Geriatrics, The University of Chicago, 5841 Maryland Avenue MC 2050, Chicago, IL, 60637, USA
| | - Heather T Gold
- Department of Population Health, NYU Grossman School of Medicine, 550 First Ave, VZ30, 6th floor, New York, NY, 10016, USA
| | - Donna Shelley
- Department of Public Health Policy and Management Department, NYU Global School of Public Health, 665 Broadway, 11th Floor, New York, NY, 10012, USA
| | - Chau Trinh-Shevrin
- Department of Population Health, NYU Grossman School of Medicine, 180 Madison Avenue, New York, NY, 10016, USA
| | - Nadia S Islam
- Department of Population Health, NYU Grossman School of Medicine, 180 Madison Avenue, New York, NY, 10016, USA
| |
Collapse
|
|
32
|
Joeliantina A, Norontoko DA, Anugrahini HN. Development of a nursing assessment form for patients with diabetes mellitus in a hospital: A research and development study. BELITUNG NURSING JOURNAL 2021; 7:431-437. [PMID: 37496505 PMCID: PMC10367994 DOI: 10.33546/bnj.1601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 07/14/2021] [Accepted: 09/06/2021] [Indexed: 07/28/2023] Open
Abstract
Background People with Diabetes Mellitus (DM) tend to seek herbal medicine or complementary drugs in their treatments. But, unfortunately, the existing nursing assessment forms have not prepared the format for the use of complementary medicine. Objective This study aimed to develop a nursing assessment form in patients with DM based on the Chronic Care Model (CCM) approach. Methods This study employed a Research and Development study design, which consists of ten stages. The nursing assessment form was developed based on CCM theory and integrated complementary medicines into the assessment form. A content validity test was done by four experts and calculated using Aiken's V formula. Face validity among 12 nurses through Focus Group Discussions (FGDs) was also employed to test the quality of the nursing assessment form based on three aspects: functionality, efficiency, and usability. In addition, nine nurses were included for pilot testing of the form. Data were analyzed using descriptive analysis. Results The nursing assessment form demonstrated a good content validity, with Aiken's V value of 0.94. The form was categorized based on four components of CCM: self-management support, decision support, social activities, and clinical information. Additionally, all nurses could fill the form properly. Conclusion The nursing assessment form is valid. It can be used for nurses to assess patients with DM based on the CCM with an additional component to evaluate the use of complementary medicine.
Collapse
Affiliation(s)
- Anita Joeliantina
- Department of Nursing, Politeknik Kesehatan Kemenkes Surabaya, Indonesia
| | - Dwi Adji Norontoko
- Department of Nursing, Politeknik Kesehatan Kemenkes Surabaya, Indonesia
| | | |
Collapse
|
|
33
|
Abdulrhim S, Awaisu A, Ibrahim MIM, Diab MI, Hussain MAM, Al Raey H, Ismail MT, Sankaralingam S. Impact of pharmacist-involved collaborative care on diabetes management in a primary healthcare setting using real-world data. Int J Clin Pharm 2021; 44:153-162. [PMID: 34637104 DOI: 10.1007/s11096-021-01327-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 09/01/2021] [Indexed: 10/20/2022]
Abstract
Background Diabetes mellitus is a complex multi-system disorder, requiring multi-disciplinary care. The conventional care model, where physicians are the sole caregivers may not be optimal. Addition of other healthcare team members improves healthcare outcomes for patients with diabetes. Aim To evaluate the impact of pharmacist-involved collaborative care on diabetes-related outcomes among patients with diabetes attending a primary healthcare setting in Qatar using real-world data. Method A retrospective cohort study was conducted among patients with diabetes attending Qatar Petroleum Diabetes Clinic. Patients were categorized as either receiving pharmacist-involved collaborative care (intervention group) or usual care (control group). Data were analyzed using SPSS®. Glycemic control (glycated hemoglobin A1c, HbA1c), blood pressure, lipid profile, and body mass index were evaluated at baseline and up to 17 months of follow-up. Results After 17 months of follow-up, pharmacist-involved collaborative care compared to usual care resulted in a significant decrease in HbA1c (6.8 ± 1.2% vs. 7.1 ± 1.3%, p < 0.01). Moreover, compared to baseline, pharmacist-involved collaborative care significantly improved (p < 0.05) the levels of HbA1c (7.5% vs. 6.8%), low-density lipoprotein cholesterol (3.7 mmol/L vs. 2.8 mmol/L), total cholesterol (5.43 mmol/L vs. 4.34 mmol/L), and body mass index (30.42 kg/m2 vs. 30.17 kg/m2) after 17 months within the intervention group. However, no significant changes for these parameters occurred within the control group. Conclusion The implementation of pharmacist-involved collaborative care in a primary healthcare setting improved several diabetes-related outcomes over 17 months. Future studies should determine the long-term impact of this care model.
Collapse
Affiliation(s)
- Sara Abdulrhim
- Department of Clinical Pharmacy and Practice, College of Pharmacy, QU Health, Qatar University, Doha, Qatar
| | - Ahmed Awaisu
- Department of Clinical Pharmacy and Practice, College of Pharmacy, QU Health, Qatar University, Doha, Qatar
| | | | - Mohammad Issam Diab
- Department of Clinical Pharmacy and Practice, College of Pharmacy, QU Health, Qatar University, Doha, Qatar
| | | | - Hend Al Raey
- Qatar Petroleum Diabetes Clinic, Qatar Petroleum Healthcare Center, Dukhan, Qatar
| | | | | |
Collapse
|
|
34
|
Sahar NH, Badlishah-Sham SF, Ramli AS. Adaptation and Psychometric Validation of the EMPOWER-SUSTAIN Usability Questionnaire (E-SUQ) among Patients with Metabolic Syndrome in Primary Care. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18179405. [PMID: 34502011 PMCID: PMC8431134 DOI: 10.3390/ijerph18179405] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Revised: 08/27/2021] [Accepted: 08/29/2021] [Indexed: 11/16/2022]
Abstract
Self-management support is one of the most important components of the Chronic Care Model (CCM). The EMPOWER-SUSTAIN Global Cardiovascular Risks Self-Management Booklet© was developed for patients with Metabolic Syndrome (MetS), inspired by the CCM. Assessing usability of a self-management tool is important in chronic disease management. However, there was no available instrument to assess usability of a self-management booklet, as most instruments were developed to assess usability of mobile application. Therefore, this study aimed to adapt Skala Kebolehgunaan Aplikasi Mudah Alih (SKAMA) into the EMPOWER-SUSTAIN Usability Questionnaire (E-SUQ) and to determine its validity and reliability in assessing usability of a self-management booklet. A cross-sectional validation study was conducted among patients with MetS attending a university primary care clinic in Selangor, Malaysia. Content validation, adaptation and face validation of E-SUQ were performed according to recommended guidelines. It underwent two rounds of content validation as major revision was required for item 5. Subsequently, the revised E-SUQ was face-validated by 10 participants. Psychometric evaluation was conducted using principal component analysis with varimax rotation to determine the underlying structure of E-SUQ. Internal consistency reliability was assessed using Cronbach’s α coefficient and the test-retest reliability was assessed using intraclass correlation coefficient (ICC (2,k)). A total of 205 patients participated in the study. The item-level content-validity-index (I-CVI) for item 5 improved from 0.57 to 1.0 after the second round of content validation. The final S-CVI/Ave value for ESUQ was >0.90. The item-level face-validity-index (I-FVI) ranged between 0.9 and 1.0. Kaiser-Meyer-Olkin value of 0.871 and Bartlett’s test of sphericity p-value of <0.05 indicated good sample adequacy for factor analysis. Two factors with eigenvalues of >1 were extracted according to the Kaiser’s Criteria. The two extracted factors explained 60.6% of the cumulative percentage of variance. The elbow of the scree plot occurred between the second and third component, suggesting two factors to be retained. The two factors were consistent with “Positive” and “Negative” tone model. The overall Cronbach’s α coefficient was 0.77, indicating good internal reliability. The overall ICC was 0.85, indicating good reproducibility. The E-SUQ is shown to be valid, reliable and stable to measure the usability of a self-management booklet among patients with MetS in a university primary care clinic in Malaysia.
Collapse
Affiliation(s)
- Nurul Hidayatullaila Sahar
- Department of Primary Care Medicine, Faculty of Medicine, Universiti Teknologi MARA, Jalan Prima Selayang 7, Batu Caves 68100, Selangor, Malaysia; (N.H.S.); (S.F.B.-S.)
| | - Siti Fatimah Badlishah-Sham
- Department of Primary Care Medicine, Faculty of Medicine, Universiti Teknologi MARA, Jalan Prima Selayang 7, Batu Caves 68100, Selangor, Malaysia; (N.H.S.); (S.F.B.-S.)
| | - Anis Safura Ramli
- Department of Primary Care Medicine, Faculty of Medicine, Universiti Teknologi MARA, Jalan Prima Selayang 7, Batu Caves 68100, Selangor, Malaysia; (N.H.S.); (S.F.B.-S.)
- Institute of Pathology, Laboratory & Forensic Medicine (I-PPerForM), Universiti Teknologi MARA, Jalan Hospital, Sungai Buloh 47000, Selangor, Malaysia
- Correspondence:
| |
Collapse
|
|
35
|
Heisler M, Simmons D, Piatt GA. Update on Approaches to Improve Delivery and Quality of Care for People with Diabetes. Endocrinol Metab Clin North Am 2021; 50:e1-e20. [PMID: 34763822 DOI: 10.1016/j.ecl.2021.07.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
To translate improvements in diabetes management into improved outcomes, it is essential to improve care delivery. To help guide clinicians and health organizations in their efforts to achieve these improvements, this article briefly describes key components underpinning effective diabetes care and six categories of innovations in approaches to improve diabetes care delivery: (1) team-based clinical care; (2) cross-specialty collaboration/integration; (3) virtual clinical care/telehealth; (4) use of community health workers (CHWs) and trained peers to provide pro-active self-management support; (5) incorporating screening for and addressing social determinants of health into clinical practice; and (6) cross-sectoral clinic/community partnerships.
Collapse
Affiliation(s)
- Michele Heisler
- Department of Internal Medicine, University of Michigan Medical School; Veterans Affairs Center for Clinical Management Research, VA Ann Arbor Healthcare System; Department of Health Behavior and Health Education, School of Public Health, University of Michigan.
| | - David Simmons
- School of Medicine, Western Sydney University, Sydney, Australia; Macarthur Clinical School, Campbelltown Hospital, Therry Road, Campbelltown, New South Wales 2560, Australia
| | - Gretchen A Piatt
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan; Department of Learning Health Sciences, University of Michigan Medical School, 1111 E. Catherine Street, Victor Vaughan Building, Room 225, Ann Arbor, MI 48109, USA
| |
Collapse
|
|
36
|
An L, Wang Y, Cao C, Chen T, Zhang Y, Chen L, Ren S, Tang M, Ma F, Li X, Yuan S, Zhao W, Lee Y, Xiao J. Screening cardiovascular risk factors of diabetes patients in the primary diabetes clinics. Medicine (Baltimore) 2021; 100:e26722. [PMID: 34397707 PMCID: PMC8322505 DOI: 10.1097/md.0000000000026722] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 06/05/2021] [Accepted: 07/04/2021] [Indexed: 01/04/2023] Open
Abstract
ABSTRACT To evaluate the atherosclerotic cardiovascular diseases (ASCVD) risk factors in type 2 diabetes patients from the primary diabetes clinics for further comprehensive intervention in China.A cross-sectional study was conducted in 5 primary diabetes chain hospitals in Beijing, Lanzhou, Harbin, Chengdu, and Taiyuan in continuous patients with type 2 diabetes from March 2016 to December 2019. The data collected at the first visit were analyzed, and proportions of patients reached the targets (glycosylated hemoglobin [HbA1c] < 7%, blood pressure < 130/80 mm Hg, and low-density lipoprotein cholesterol [LDL-C] < 2.6mmol/l) were calculated. The clinical characteristics and the associated factors with achievement in HbA1c, blood pressure, and LDL-C targets were analyzed.A total of 20,412 participants, including 11,353 men (55.6%), with an average age of (59.4 ± 10.4) years were enrolled. Nearly 95% diabetes had one or more ASCVD risk factors other than hyperglycemia. The control rates of HbA1c, blood pressure, and LDL-C were 26.5%, 27.8%, and 42.6%, respectively. Only 4.1% patients achieved all 3 targets. Nearly 95% patients had one or more ASCVD risk factors other than hyperglyciemia. Diabetes duration, family history, and overweight/obesity were associated with the number of aggregated ASCVD risk factors. The patients with older age, no overweight/obesity, not smoking, less ASCVD risk factors, and having special diabetes care insurance (Chengdu) were associated with a higher control rates.To deal with poor control status, global management of ASCVD risk factors, weight loss, and smoking cessation must be emphasized in the primary diabetes care settings. Special diabetes care insurance should be advocated.Current ClinicalTrial.gov protocol ID NCT03707379. Date of Registration: October 16, 2018. https://clinicaltrials.gov.
Collapse
Affiliation(s)
| | - Yanlei Wang
- Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University
| | - Chenxiang Cao
- Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University
| | - Tao Chen
- Chengdu Ryan Diabetes Hospital, Chengdu
| | | | | | | | | | | | | | - Shuang Yuan
- Heilongjiang Ruijing Diabetes Hospital, Harbin, Heilongjiang, China
| | - Wenhui Zhao
- Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University
| | - Yaujiunn Lee
- Lee's Clinic, No. 130, Min-Zu Rd, Pingtung, Taiwan
| | - Jianzhong Xiao
- Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University
| |
Collapse
|
|
37
|
Lee J, Kim KH, Ahn JC, Kim JA, Lee G, Son JS, Choi SJ, Oh YH, Park SM. Prevalence, awareness, treatment, and control of diabetes mellitus by depressive symptom severity: a cross-sectional analysis of NHANES 2011-2016. BMJ Open Diabetes Res Care 2021; 9:e002268. [PMID: 34099441 PMCID: PMC8186749 DOI: 10.1136/bmjdrc-2021-002268] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Accepted: 05/11/2021] [Indexed: 01/13/2023] Open
Abstract
INTRODUCTION Despite extensive studies on the relationship between diabetes mellitus (DM) and depression, the associations of depressive symptom severity with prevalence, awareness, treatment, and control of diabetes remain unclear. We aimed to investigate changes in these outcomes of diabetes as depressive symptoms aggravate. RESEARCH DESIGN AND METHODS We conducted a cross-sectional analysis of 14 328 participants in the 2011-2016 National Health and Nutrition Examination Survey. Participants were classified into depressive symptom groups of none, mild, moderate, moderately severe, and severe depending on their Patient Health Questionnaire-9 scores. Multivariate logistic regression analyses were conducted in three models adjusted for expanding confounders to evaluate the associations between severity of depressive symptoms and prevalence, awareness, treatment, and control of DM. RESULTS As depressive symptom severity worsened, both prevalence and awareness of DM increased regardless of models (p value for trend <0.01 in all models for prevalence and awareness; adjusted OR (aOR) 2.14, 95% CI 1.29 to 3.56 for prevalence in the severe group, model 1; aOR 2.43, 95% CI 1.27 to 4.64 for awareness in the moderately severe group, model 1). Notwithstanding higher awareness of diabetes in the moderately severe and severe groups (84.5% and 86.2%, respectively, vs 71.3% in the none group), these groups were treated less (aOR 0.25, 95% CI 0.11 to 0.55 in the severe group, model 3) or inadequately controlled (aOR 0.51, 95% CI 0.27 to 0.98 in the moderately severe group, model 3). CONCLUSIONS The gap between patients' higher awareness and lower treatment rate or control of diabetes among individuals with severe depressive symptoms highlights the unmet needs for postdiagnostic multidisciplinary care for patients with comorbid depression and DM.
Collapse
Affiliation(s)
- Jaewon Lee
- Department of Biomedical Sciences, Seoul National University Hospital, Seoul, Korea (the Republic of)
| | - Kyae Hyung Kim
- Department of Family Medicine, Seoul National University Hospital, Seoul, Korea (the Republic of)
| | - Joseph C Ahn
- Division of Gastroenterology and Hepatology, Mayo Clinic in Rochester, Rochester, Minnesota, USA
| | - Jihoon Andrew Kim
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Gyeongsil Lee
- Department of Family Medicine, Seoul National University Hospital, Seoul, Korea (the Republic of)
| | - Joung Sik Son
- Department of Family Medicine, Korea University Guro Hospital, Seoul, Korea (the Republic of)
| | - Soo Jung Choi
- Department of Family Medicine, Gachon University Gil Medical Center, Incheon, Korea (the Republic of)
| | - Yun Hwan Oh
- Department of Family Medicine, Jeju National University Hospital, Jeju, Korea (the Republic of)
| | - Sang Min Park
- Department of Biomedical Sciences, Seoul National University Hospital, Seoul, Korea (the Republic of)
- Department of Family Medicine, Seoul National University Hospital, Seoul, Korea (the Republic of)
| |
Collapse
|
|
38
|
Chen TT, Oldenburg B, Hsueh YS. Chronic care model in the diabetes pay-for-performance program in Taiwan: Benefits, challenges and future directions. World J Diabetes 2021; 12:578-589. [PMID: 33995846 PMCID: PMC8107979 DOI: 10.4239/wjd.v12.i5.578] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2020] [Revised: 02/08/2021] [Accepted: 04/05/2021] [Indexed: 02/06/2023] Open
Abstract
In this review, we discuss the chronic care model (CCM) in relation to the diabetes pay-for-performance (P4P) program in Taiwan. We first introduce the 6 components of the CCM and provide a detailed description of each of the activities in the P4P program implemented in Taiwan, mapping them onto the 6 components of the CCM. For each CCM component, the following three topics are described: the definition of the CCM component, the general activities implemented related to this component, and practical and empirical practices based on hospital or local government cases. We then conclude by describing the possible successful features of this P4P program and its challenges and future directions. We conclude that the successful characteristics of this P4P program in Taiwan include its focus on extrinsic and intrinsic incentives (i.e., shared care network), physician-led P4P and the implementation of activities based on the CCM components. However, due to the low rate of P4P program coverage, approximately 50% of patients with diabetes cannot enjoy the benefits of CCM-related activities or receive necessary examinations. In addition, most of these CCM-related activities are not allotted an adequate amount of incentives, and these activities are mainly implemented in hospitals, which compared with primary care providers, are unable to execute these activities flexibly. All of these issues, as well as insufficient implementation of the e-CCM model, could hinder the advanced improvement of diabetes care in Taiwan.
Collapse
Affiliation(s)
- Tsung-Tai Chen
- Department of Public Health, College of Medicine, Fu Jen Catholic University, New Taipei 24205, Taiwan
| | - Brian Oldenburg
- Noncommunicable Disease Control Unit, Melbourne School of Population and Global Health, University of Melbourne, Melbourne 3053, Australia
| | - Ya-Seng Hsueh
- Centre for Health Policy, Melbourne School of Population and Global Health, University of Melbourne, Melbourne 3053, Australia
| |
Collapse
|
|
39
|
Chiou S, Liao K, Huang Y, Lin W, Hsieh C. Synergy between the pay-for-performance scheme and better physician-patient relationship might reduce the risk of retinopathy in patients with type 2 diabetes. J Diabetes Investig 2021; 12:819-827. [PMID: 33025682 PMCID: PMC8089022 DOI: 10.1111/jdi.13422] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 09/19/2020] [Accepted: 09/24/2020] [Indexed: 12/16/2022] Open
Abstract
AIMS/INTRODUCTION This study investigated whether participation by patients with type 2 diabetes in Taiwan's pay-for-performance (P4P) program and maintaining good continuity of care (COC) with their healthcare provider reduced the likelihood of future complications, such as retinopathy. MATERIALS AND METHODS The analysis used longitudinal panel data for newly diagnosed type 2 diabetes from the National Health Insurance claims database in Taiwan. COC was measured annually from 2003 to 2013, and was used to allocate the patients to low, medium and high groups. Cox regression analysis was used with time-dependent (time-varying) covariates in a reduced model (with only P4P or COC), and the full model was adjusted with other covariates. RESULTS Despite the same significant effects of treatment at primary care, the Diabetes Complications Severity Index scores were significantly associated with the development of retinopathy. After adjusting for these, the hazard ratios for developing retinopathy among P4P participants in the low, medium and high COC groups were 0.594 (95% confidence interval [CI] 0.398-0.898, P = 0.012), 0.676 (95% CI 0.520-0.867, P = 0.0026) and 0.802 (95% CI 0.603-1.030, P = 0.1062), respectively. Thus, patients with low or median COC who participated in the P4P program had a significantly lower risk of retinopathy than those who did not. CONCLUSIONS Diabetes care requires a long-term relationship between patients and their care providers. Besides encouraging patients to participate in P4P programs, health authorities should provide more incentives for providers or patients to regularly survey patients' lipid profiles and glucose levels, and reward the better interpersonal relationship to prevent retinopathy.
Collapse
Affiliation(s)
- Shang‐Jyh Chiou
- Department of Health Care ManagementNational Taipei University of Nursing and Health SciencesTaipeiTaiwan
| | - Kuomeng Liao
- Department of Endocrinology and MetabolismZhongxiao BranchTaipei City HospitalTaipeiTaiwan
| | - Yu‐Tung Huang
- Center for Big Data Analytics and StatisticsChang Gung Memorial HospitalTaoyuan CityTaiwan
| | - Wender Lin
- Department of Health Care AdministrationChang Jung Christian UniversityTainan CityTaiwan
| | - Chi‐Jeng Hsieh
- Department of Health Care AdministrationOriental Institute of TechnologyNew Taipei CityTaipeiTaiwan
| |
Collapse
|
|
40
|
Al-Badri M, Hamdy O. Diabetes clinic reinvented: will technology change the future of diabetes care? Ther Adv Endocrinol Metab 2021; 12:2042018821995368. [PMID: 33854751 PMCID: PMC8010847 DOI: 10.1177/2042018821995368] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 01/16/2021] [Indexed: 12/12/2022] Open
Abstract
Diabetes is a chronic disease that affects nearly 463 million people globally and involves multiple co-morbid conditions that require effective treatment and continuous management. These include lifestyle and behavioral modifications, compliance to diabetes medications and close patient monitoring, all of which can be efficiently conducted via telehealth. Integrating digital technology of telehealth and mobile health into diabetes care may improve diabetes management and increase its efficiency. In this review, we examine recent advances in healthcare technology of diabetes. Moreover, we present an example of a comprehensive virtual diabetes clinic, the "Joslin HOME," as an innovative digital ecosystem for future application in diabetes care. This model utilizes digital health technology and comprises frequent short visits with easy two-way scheduling, focused documentation and simple billing methods. In this new model, a multidisciplinary team is connected with their patients using telehealth and mobile health to overcome the barriers of distance and location. It may possibly extend quality diabetes care to remote, underserved or rural areas.
Collapse
Affiliation(s)
- Marwa Al-Badri
- Joslin Diabetes Center, Affiliated with Harvard Medical School, Boston, MA 02215, USA.
| | - Osama Hamdy
- Medical Director of Inpatient Diabetes Program, Joslin Diabetes Center, Boston, MA 02215, USA
| |
Collapse
|
|
41
|
Abdulrhim S, Sankaralingam S, Ibrahim MIM, Diab MI, Hussain MAM, Al Raey H, Ismail MT, Awaisu A. Collaborative care model for diabetes in primary care settings in Qatar: a qualitative exploration among healthcare professionals and patients who experienced the service. BMC Health Serv Res 2021; 21:192. [PMID: 33653324 PMCID: PMC7927378 DOI: 10.1186/s12913-021-06183-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Accepted: 02/16/2021] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Diabetes mellitus is highly prevalent and associated with huge economic burden globally. The conventional care and management of diabetes mellitus is highly fragmented and complex, warranting the need for a comprehensive Collaborative Care Model (CCM). Little is known about the perception of patients with diabetes and their healthcare providers about CCM, its barriers and facilitators. This study aimed to explore the value of CCM in diabetes care at a primary healthcare (PHC) setting from the perspective of patients with diabetes and healthcare professionals (HCPs), in an effort to expand our current knowledge on collaborative care in diabetes at primary care level for the purpose of quality improvement and service expansion. METHODS Using an exploratory case study approach, semi-structured interviews were conducted among patients and HCPs who encountered CCM in Qatar during 2019 and 2020. The semi-structured interviews were transcribed verbatim and the data were analysed and interpreted using a deductive-inductive thematic analysis approach. RESULTS Twelve patients and 12 HCPs at a diabetes clinic participated in one-to-one interviews. The interviews resulted in five different themes: the process and components of collaborative care model (four subthemes), current organizational support and resources (three subthemes), impact of collaborative care model on diabetes outcomes (three subthemes), enablers of collaborative care model (three subthemes), and barriers to collaborative care model (three subthemes). The participants indicated easy access to and communication with competent and pleasant HCPs. The patients appreciated the extra time spent with HCPs, frequent follow-up visits, and health education, which empowered them to self-manage diabetes. HCPs believed that successful CCM provision relied on their interest and commitment to care for patients with diabetes. Generally, participants identified barriers and facilitators that are related to patients, HCPs, and healthcare system. CONCLUSIONS The providers and users of CCM had an overall positive perception and appreciation of this model in PHC settings. Barriers to CCM such as undesirable attributes of HCPs and patients, unsupportive hospital system, and high workload must be addressed before implementing the model in other PHC settings.
Collapse
Affiliation(s)
- Sara Abdulrhim
- Department of Clinical Pharmacy and Practice, College of Pharmacy, QU Health, Qatar University, Doha, Qatar
| | | | | | - Mohammed Issam Diab
- Department of Clinical Pharmacy and Practice, College of Pharmacy, QU Health, Qatar University, Doha, Qatar
| | | | - Hend Al Raey
- Qatar Petroleum Healthcare Center, Dukhan, Qatar
| | | | - Ahmed Awaisu
- Department of Clinical Pharmacy and Practice, College of Pharmacy, QU Health, Qatar University, Doha, Qatar.
| |
Collapse
|
|
42
|
Aghili R, Valojerdi AE, Farshchi A, Khamseh ME. Type 2 diabetes: patient assessment of chronic illness care. J Diabetes Metab Disord 2021; 20:7-13. [PMID: 34178820 DOI: 10.1007/s40200-020-00540-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Accepted: 05/06/2020] [Indexed: 12/21/2022]
Abstract
Objective We tried to assess perception of chronic illness care in people with type 2 diabetes and to determine whether demographic variables, self-care behavior, as well as affective variables were related with perception of chronic illness care. Methods We conducted a secondary analysis of the previously published cross-sectional study in 441 Iranian people with type 2 diabetes. Chronic illness care was assessed with the validated tool of patient assessment of chronic illness care (PACIC). Different aspects of care according to the chronic care model are measured on a scale of 1-5, with 5 being highest perception of care. The association between perception of chronic illness care and measured variables were tested using spearman correlation test as well as univariate and multiple linear regression analysis. Results Finally, 380 filled out the PACIC questionnaire, completely (53.4% female, mean age: 54.73 ± 8.0 years, mean PACIC score: 2.52 ± 0.87). In spearman correlation test, considering PACIC score as the dependent variable, chronic illness care was inversely associated with level of education and distress, whereas, insulin treatment, wellbeing, family-social support and self-management were positively associated with chronic care (All p value<0.05). In the multiple linear regression analysis, family-social support was positively related to chronic care while level of education, marital status, diabetes-related distress, and high density lipoprotein had significant negative relationship with PACIC score (All p value<0.05). Conclusions Family-social support, level of education, marital status, and diabetes-related distress are the major determinants of patient experience of chronic illness care in people with type 2 diabetes.
Collapse
Affiliation(s)
- Rokhsareh Aghili
- Endocrine Research Center, Institute of Endocrinology and Metabolism, Iran University of Medical Sciences, No. 10, Firoozeh St., South Vali-asr Ave., Vali-asr Sq., Tehran, 15937-16615 Iran
| | - Ameneh Ebrahim Valojerdi
- Endocrine Research Center, Institute of Endocrinology and Metabolism, Iran University of Medical Sciences, No. 10, Firoozeh St., South Vali-asr Ave., Vali-asr Sq., Tehran, 15937-16615 Iran
| | - Amir Farshchi
- Endocrine Research Center, Institute of Endocrinology and Metabolism, Iran University of Medical Sciences, No. 10, Firoozeh St., South Vali-asr Ave., Vali-asr Sq., Tehran, 15937-16615 Iran.,Department of Pharmacoeconomics and Pharmaceutical Administration, School of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Ebrahim Khamseh
- Endocrine Research Center, Institute of Endocrinology and Metabolism, Iran University of Medical Sciences, No. 10, Firoozeh St., South Vali-asr Ave., Vali-asr Sq., Tehran, 15937-16615 Iran
| |
Collapse
|
|
43
|
Patrascu R, Albai A, Braha A, Gaita L, Lazar S, Potre O, Timar B. Instrument for Assessing Patients' Desirability, Acceptability, and Adherence to Telemedicine in Diabetes: Development, Validity, and Reliability. Patient Prefer Adherence 2021; 15:2705-2713. [PMID: 34898981 PMCID: PMC8654690 DOI: 10.2147/ppa.s343869] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 11/22/2021] [Indexed: 11/23/2022] Open
Abstract
PURPOSE To develop, test, and validate an instrument for assessing patients' desirability, acceptability, and adherence to telemedicine in diabetes. PATIENTS AND METHODS A group of six experts defined the components that needed to be assessed when developing telemedicine platforms aimed at improving the care of patients with diabetes. The resulting instrument was tested for reliability and construct validity of 114 patients with diabetes and re-tested for reproducibility and consistency on a sub-group of 34 patients. Based on the analysis, the questionnaire's syntax, phrasing, and flow were improved to obtain optimal assessment results. RESULTS The resulting questionnaire has three major sections: one for the main evaluated component (acceptability, desirability, and adherence to telemedicine in diabetes), one for collecting socio-economic and demographical information, and one for diabetes history-related data, respectively. The corresponding data for these sections are collected using 29 questions. The developed instrument has a good reliability (Cronbach's alpha = 0.890), reproducibility (Total score 164 vs 166 points at re-test vs test; Mann-Whitney U p-value = 0.394) and external validity (Spearman's rho = -0.580; p < 0.001 for correlation with Patient's Health Questionnaire -9; and Spearman's rho = -0.516; p < 0.001 for correlation with Generalized Anxiety Disorder - 7). CONCLUSION The developed questionnaire is a valid and reliable instrument in assessing the patients' acceptability, desirability, and adherence to telemedicine use in diabetes care. In addition, the use of this instrument in the development of telemedicine platforms may improve and optimize their usage by providing valuable information regarding patients' preferences and specific needs.
Collapse
Affiliation(s)
- Raul Patrascu
- Department of Functional Sciences, “Victor Babes” University of Medicine and Pharmacy, Timisoara, Romania
- “Pius Brinzeu” Emergency Hospital, Timisoara, Romania
| | - Alin Albai
- “Pius Brinzeu” Emergency Hospital, Timisoara, Romania
- Second Department of Internal Medicine, “Victor Babes” University of Medicine and Pharmacy, Timisoara, Romania
- Correspondence: Alin Albai Tel +40721435829Fax +40256490626 Email
| | - Adina Braha
- “Pius Brinzeu” Emergency Hospital, Timisoara, Romania
- Second Department of Internal Medicine, “Victor Babes” University of Medicine and Pharmacy, Timisoara, Romania
| | - Laura Gaita
- “Pius Brinzeu” Emergency Hospital, Timisoara, Romania
- Second Department of Internal Medicine, “Victor Babes” University of Medicine and Pharmacy, Timisoara, Romania
| | - Sandra Lazar
- Second Department of Internal Medicine, “Victor Babes” University of Medicine and Pharmacy, Timisoara, Romania
| | - Ovidiu Potre
- First Department of Internal Medicine, “Victor Babes” University of Medicine and Pharmacy, Timisoara, Romania
| | - Bogdan Timar
- “Pius Brinzeu” Emergency Hospital, Timisoara, Romania
- Second Department of Internal Medicine, “Victor Babes” University of Medicine and Pharmacy, Timisoara, Romania
| |
Collapse
|
|
44
|
Cheng AYY, Bajaj HS, Clement M, Sherifali D, Eisen D, Heisel O, Keown P, Richard JF. Assessing the Effect of Quality-Improvement Strategies for Organization of Care in Type 2 Diabetes Outcomes in Adults: Aim-Strait. Can J Diabetes 2020; 45:319-326.e5. [PMID: 33223422 DOI: 10.1016/j.jcjd.2020.09.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 07/20/2020] [Accepted: 09/28/2020] [Indexed: 11/19/2022]
Abstract
OBJECTIVES To observe the effect of an organization-of-care improvement process on the achievement of therapeutic goals for people with type 2 diabetes mellitus (T2DM). METHODS This single-arm cohort study analyzed the electronic medical records of patients with T2DM in 5 primary care practices in Ontario, Canada, before and 2 years after implementation of an individualized quality-improvement program. The primary outcome was the change in glycated hemoglobin (A1C) between baseline and follow up, with secondary analyses including change in other metabolic parameters, medication patterns and clinic visits. Prespecified subgroup analysis of patients with baseline values above guideline therapeutic targets was performed. RESULTS In the overall population of 1,886 patients, A1C improved from 7.1% (baseline) to 7.0% (follow up) (p<0.001); low-density lipoprotein-cholesterol (LDL-C) improved from 2.1 to 1.9 mmol/L (p<0.001); and diastolic blood pressure (BP) improved from 75 to 74 mmHg (p<0.001), with no significant change observed in systolic BP. Of those patients who were above guideline-recommended therapeutic targets at baseline, improvements were observed at follow-up: A1C 8.3±1.3% to 7.8±1.3% (p<0.001), LDL-C 2.9±0.7 mmol/L to 2.4±0.9 mmol/L (p<0.001), systolic BP 144±11 to 134±16 mmHg (p<0.001) and diastolic BP 80±10 to 75±11 mmHg (p<0.001), with the percentages of patients achieving target at follow up being 32% for A1C, 40% for LDL-C and 49% for systolic BP. Overall, 22% of patients achieved all 3 targets at baseline compared to 28% at follow up (p<0.001). CONCLUSIONS The implementation of an organization-of-care improvement program in primary care was associated with improved metabolic control, which was most pronounced in patients with baseline levels above guideline-recommended therapeutic targets.
Collapse
Affiliation(s)
- Alice Y Y Cheng
- Department of Medicine, University of Toronto, Trillium Health Partners and Unity Health Toronto, Toronto, Ontario, Canada.
| | | | - Maureen Clement
- Department of Family Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Diana Sherifali
- School of Nursing, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Doron Eisen
- West Durham Family Health Team, Pickering, Ontario, Canada
| | - Olaf Heisel
- Syreon Corporation, Vancouver, British Columbia, Canada
| | - Paul Keown
- Syreon Corporation, Vancouver, British Columbia, Canada; Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | | |
Collapse
|
|
45
|
Lim S, Islam NS. Small Practices, Big (QI) Dreams: Customizing QI Efforts for Under-resourced Primary Care Practices to Improve Diabetes Disparities (Preprint). JMIR Diabetes 2020; 7:e23844. [PMID: 35302500 PMCID: PMC8976251 DOI: 10.2196/23844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 04/02/2021] [Accepted: 01/13/2022] [Indexed: 11/16/2022] Open
Abstract
Electronic health record quality improvement (QI) initiatives hold great promise in improving adoption of clinical practice guidelines, including those related to diabetes. QI initiatives implemented in under-resourced primary care settings that primarily serve racial/ethnic minority populations have potential to improve quality of care and ultimately improve diabetes disparities. The “Screen at 23” campaign was launched in 2011 to increase screening for prediabetes and diabetes at lower BMI thresholds (ie, 23 kg/m2) for Asian Americans, in line with the new guidelines put forth by the American Diabetes Association. Here, we describe the implementation of a customized electronic health record QI initiative in under-resourced practices that primarily serve low-income South Asian populations in New York City, designed to increase diabetes screening using updated BMI guidelines and in alignment with the “Screen at 23” campaign. The customization involved the implementation of an innovative, semi-manual alternate solution to automated clinical decision support system (CDSS) alerts in order to address the restrictions on customizing CDSS alerts in electronic health record platforms used in small practice settings. We also discuss challenges and strategies with this customized QI effort. Our experience suggests that multisector partnership engagement, user-centered approaches, and informal strategies for relationship building are even more critical in under-resourced, small practice settings. Relatively simple technological solutions can be greatly beneficial in enhancing small practice capacity to engage in larger-scale QI initiatives. Tailored, context-driven approaches for implementation of equity-focused QI initiatives such as the one we describe can increase adoption of clinical practice guidelines, improve diabetes-related outcomes, and improve health disparities among underserved populations.
Collapse
Affiliation(s)
- Sahnah Lim
- Department of Population Health, Grossman School of Medicine, New York University, New York, NY, United States
| | - Nadia S Islam
- Department of Population Health, Grossman School of Medicine, New York University, New York, NY, United States
| |
Collapse
|
|
46
|
Tillman P. Applying the Chronic Care Model in a Free Clinic. J Nurse Pract 2020. [DOI: 10.1016/j.nurpra.2020.05.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
|
|
47
|
Silva-Tinoco R, Cuatecontzi-Xochitiotzi T, De la Torre-Saldaña V, León-García E, Serna-Alvarado J, Orea-Tejeda A, Castillo-Martínez L, Gay JG, Cantú-de-León D, Prada D. Influence of social determinants, diabetes knowledge, health behaviors, and glycemic control in type 2 diabetes: an analysis from real-world evidence. BMC Endocr Disord 2020; 20:130. [PMID: 32843004 PMCID: PMC7449009 DOI: 10.1186/s12902-020-00604-6] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Accepted: 07/30/2020] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Although important achievements have been done in type 2 diabetes mellitus (T2D) treatment and glycemic control, new strategies may take advantage of non-pharmacological approaches and of other potential determinants of health (e.g., socioeconomic status, education, diabetes knowledge, physical activity, and self-care behavior). However, the relationships between these factors are not totally clear and have not been studied in the context of large urban settings. This study aimed to explore the relationship between these determinants of glycemic control (GC) in a low-income urban population from Mexico City, focused in exploring potential the mediation of self-care behaviors in the association between diabetes knowledge and GC. METHODS A multicenter cross-sectional study was conducted in patients with type 2 diabetes (T2D) from 28 primary care outpatient centers located in Mexico City. Using multivariable-adjusted models, we determined the associations between diabetes knowledge, self-care behaviors, and GC. The mediation analyses to determine the pathways on glycemic control were done using linear regression models, where the significance of indirect effects was calculated with bootstrapping. RESULTS The population (N = 513) had a mean age of 53.8 years (standard deviation: 11.3 yrs.), and 65.9% were women. Both socioeconomic status and level of education were directly associated with diabetes knowledge. Using multivariable-adjusted linear models, we found that diabetes knowledge was associated with GC (β: -0.102, 95% Confidence Interval [95% CI] -0.189, - 0.014). Diabetes knowledge was also independently associated with self-care behavior (for physical activity: β: 0.181, 95% CI 0.088, 0.273), and self-care behavior was associated with GC (for physical activity: β: -0.112, 95% CI -0.194, - 0.029). The association between diabetes knowledge and GC was not observed after adjustment for self-care behaviors, especially physical activity (β: -0.084, 95% CI -0.182, 0.014, p-value: 0.062). Finally, the mediation models showed that the effect of diabetes knowledge on GC was 17% independently mediated by physical activity (p-value: 0.049). CONCLUSIONS Socioeconomic and educational gradients influence diabetes knowledge among primary care patients with type 2 diabetes. Self-care activities, particularly physical activity, mediated the effect of diabetes knowledge on GC. Our results indicate that diabetes knowledge should be reinforced in low-income T2D patients, with an emphasis on the benefits physical activity has on improving GC.
Collapse
Affiliation(s)
- Rubén Silva-Tinoco
- Clínica Especializada en el Manejo de la Diabetes en la Ciudad de México, Servicios de Salud Pública de la Ciudad de México, Alfonso Toro s/n, Col. Escuadrón 201, Iztapalapa, 09060, Mexico City, Mexico.
| | - Teresa Cuatecontzi-Xochitiotzi
- Clínica Especializada en el Manejo de la Diabetes en la Ciudad de México, Servicios de Salud Pública de la Ciudad de México, Alfonso Toro s/n, Col. Escuadrón 201, Iztapalapa, 09060, Mexico City, Mexico
| | - Viridiana De la Torre-Saldaña
- Clínica Especializada en el Manejo de la Diabetes en la Ciudad de México, Servicios de Salud Pública de la Ciudad de México, Alfonso Toro s/n, Col. Escuadrón 201, Iztapalapa, 09060, Mexico City, Mexico
| | - Enrique León-García
- Servicios de Salud Pública del Gobierno de la Ciudad de México, Mexico City, Mexico
| | | | - Arturo Orea-Tejeda
- Heart Failure and Respiratory Distress Clinic at Instituto Nacional de Enfermedades Respiratorias "Ismael Cosío Villegas", Mexico City, Mexico
| | - Lilia Castillo-Martínez
- Departamento de Nutriología Clínica, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Juan G Gay
- Tecnología e Información para la Salud, TIS, Mexico City, Mexico
| | - David Cantú-de-León
- Unidad de Investigación Biomédica en Cáncer, Instituto Nacional de Cancerología - Instituto de Investigaciones Biomédicas, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - Diddier Prada
- Unidad de Investigación Biomédica en Cáncer, Instituto Nacional de Cancerología - Instituto de Investigaciones Biomédicas, Universidad Nacional Autónoma de México, Mexico City, Mexico
- Support and Research Promotion Program (AFINES), Faculty of Medicine, Universidad Nacional Autónoma de México (UNAM), Mexico City, Mexico
- Department of Biomedical Informatics, Faculty of Medicine, Universidad Nacional Autónoma de México (UNAM), Mexico City, Mexico
- Department of Environmental Health Science, Mailman School of Public Health, Columbia University, New York City, USA
| |
Collapse
|
|
48
|
Sibounheuang P, Olson PS, Kittiboonyakun P. Patients' and healthcare providers’ perspectives on diabetes management: A systematic review of qualitative studies. Res Social Adm Pharm 2020; 16:854-874. [DOI: 10.1016/j.sapharm.2019.09.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Revised: 08/22/2019] [Accepted: 09/01/2019] [Indexed: 12/23/2022]
|
|
49
|
Trends in Costs of Care and Utilization for Medicaid Patients With Diabetes in Accountable Care Communities. Med Care 2020; 58 Suppl 6 Suppl 1:S40-S45. [PMID: 32412952 DOI: 10.1097/mlr.0000000000001318] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND/OBJECTIVES Medicaid beneficiaries with diabetes have complex care needs. The Accountable Care Communities (ACC) Program is a practice-level intervention implemented by UnitedHealthcare to improve care for Medicaid beneficiaries. We examined changes in costs and utilization for Medicaid beneficiaries with diabetes assigned to ACC versus usual care practices. RESEARCH DESIGN Interrupted time series with concurrent control group analysis, at the person-month level. The ACC was implemented in 14 states, and we selected comparison non-ACC practices from those states to control for state-level variation in Medicaid program. We adjusted the models for age, sex, race/ethnicity, comorbidities, seasonality, and state-by-year fixed effects. We examined the difference between ACC and non-ACC practices in changes in the time trends of expenditures and hospital and emergency room utilization, for the 4 largest categories of Medicaid eligibility [Temporary Assistance to Needy Families, Supplemental Security Income (without Medicare), Expansion, Dual-Eligible]. SUBJECTS/MEASURES Eligibility and claims data from Medicaid adults with diabetes from 14 states between 2010 and 2016, before and after ACC implementation. RESULTS Analyses included 1,200,460 person-months from 66,450 Medicaid patients with diabetes. ACC implementation was not associated with significant changes in outcome time trends, relative to comparators, for all Medicaid categories. CONCLUSIONS Medicaid patients assigned to ACC practices had no changes in cost or utilization over 3 years of follow-up, compared with patients assigned to non-ACC practices. The ACC program may not reduce costs or utilization for Medicaid patients with diabetes.
Collapse
|
|
50
|
Timpel P, Lang C, Wens J, Contel JC, Schwarz PEH. The Manage Care Model - Developing an Evidence-Based and Expert-Driven Chronic Care Management Model for Patients with Diabetes. Int J Integr Care 2020; 20:2. [PMID: 32346360 PMCID: PMC7181948 DOI: 10.5334/ijic.4646] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Accepted: 03/25/2020] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Most current care models are disease- or symptom-focused and mostly do not account for the individual needs of patients with chronic diseases. The aim of this study was to develop an innovative, evidence-based and expert-based practice model for the management of patients with type 2 diabetes mellitus. METHOD An iterative approach was used combining systematic literature search with qualitative methods, including a standardised survey of experts in chronic care (n = 92), an expert workshop of professionals (n = 22) and a multilingual online survey (n = 659). Using three consensus meetings involving researchers, policy makers and experts in chronic care, a limited number of core components and care recommendations was set up to develop a new chronic care model. RESULTS The developed 'MANAGE CARE MODEL' includes aspects of the health and social care system, resources derived from the living environment, aspects of health promotion and prevention, as well as an expanded understanding of improved outcomes as an integral part of chronic care. CONCLUSION The MANAGE CARE MODEL provides guidance for the development and implementation of chronic care programs, regional networks and national strategies. Future research is needed to validate the model as an instrument of regional chronic care management.
Collapse
Affiliation(s)
- Patrick Timpel
- Prevention and Care of Diabetes, Department of Medicine III, Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Dresden, DE
| | - Caroline Lang
- Department of General Practice, Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Dresden, DE
| | - Johan Wens
- Department of Primary and Interdisciplinary Care Antwerp, University of Antwerp, Antwerp, BE
| | - Juan Carlos Contel
- Chronic Care Program, Department of Health, Integrated Health and Social Care Plan, Generalitat de Catalunya, ES
| | - Peter E. H. Schwarz
- Prevention and Care of Diabetes, Department of Medicine III, Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Dresden, DE
- Paul Langerhans Institut Dresden, German Center for Diabetes Research (DZD), Dresden, DE
| | | |
Collapse
|